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Global Health, In the News, Medical Education, Pregnancy, Women's Health

Project aims to improve maternal and newborn health in sub-Saharan Africa

Project aims to improve maternal and newborn health in sub-Saharan Africa

5567854013_6bd1e2b76b_zIn sub-Saharan Africa, maternal and neonatal outcomes are some of the worst in the world. What would happen to those numbers if 1,000 new obstetrician/gynecologists were trained with state-of-the-art educational materials in the region over the next ten years? The 1000+OBGYN Project, a collaborative training effort between American and African universities, aims to do just that.

The University of Michigan’s Open.Michigan initiative, in partnership with the UM Medical School’s Department of Obstetrics and Gynecology and Department of Learning Health Sciences, just released four new collections into the 1000+OBGYN Project’s open-access database, thanks to a grant from the World Bank.

A UM press release published today describes the new contributions, which cover a diverse range of subjects, including abnormal uterine bleeding, pregnancy complications, vaginal surgeries, pelvic masses, newborn care, postpartum care and family planning. The materials are all free, publicly available, and licensed for students, teachers and practitioners to modify according to their own curricular context.

Frank Anderson, MD, MPH, associate professor in the UM Department of Obstetrics and Gynecology and director of the 1000+OBYGN Project, comments in the release:

There is an urgent need to train Obgyns [sic] in sub-Saharan Africa, but their institutions don’t always have access to the same body of educational materials as doctors in developed countries have… Many newborn and maternal deaths are preventable. We want to ensure that future Obgyns in low resource countries have access to the same high-quality learning materials available here so they are equipped to provide the best care possible for mothers and babies.

The project hopes to overcome local barriers to good education, such as availability of training materials, licensing costs, and unreliable internet access. To make the materials available offline, the initiative partnered with the Global Library of Women’s Medicine, which compresses research onto USB flash drives and distributes them globally, particularly to women’s health professionals in Africa.

Previously: Countdown to Childx: Global health expert Gary Darmstadt on improving newborn survival, Gates Foundation makes bold moves toward open access publication of grantee research, Improving maternal mortality rate in Africa through good design and Using family planning counseling to reduce number of HIV-positive children in Africa
Photo by DFID – UK Department for International Development

Events, Pediatrics, Pregnancy, Research, Stanford News

Join us for two days of live tweeting from Childx

Join us for two days of live tweeting from Childx

Group of five happy children jumping on meadow.

Today and tomorrow, we’ll be live tweeting Stanford’s inaugural Childx conference, which brings together some of the top voices in pediatric and maternal health. We’ll be using @StanfordMed and the #StanfordChildx hashtag.

The action kicks off early today, with an 8 a.m. welcome by Lloyd Minor, MD, dean of the School of Medicine. Keynote speaker Alan Guttmacher, MD, director of the Eunice Kennedy Shriver National Institute on Child Health and Human Development, who talked with Scope last week, speaks at 8:15 a.m.

Check back throughout the day to learn about fetal, developmental and adult health at 9 a.m. and stem cell and gene therapy at 11:10 a.m. After lunch, the conference reconvenes to discuss child and maternal health at 2:20 p.m. with Alan Greene, MD, who leads the popular Dr.Greene.com. The speaking presentations wrap up at 5 p.m.

On Friday, Stanford’s Dennis Wall, PhD, will kick the conversation off at 8 a.m., followed at 8:10 a.m. by Rajiv Shah, MD, former head of the United States Agency for International Development. At 8:35 a.m., Stanford’s Euan Ashley, MD, DPhil, will lead a discussion on precision medicine for rare childhood diseases. Tune in to learn more about the health ecosystem at 10:30 a.m. and for a special presentation by Stanford’s Mary Leonard, MD at 11:55 a.m.

The complete schedule is available here.

Previously: Countdown to Childx: Global health expert Gary Darmstadt on improving newborn survivalCountdown to Childx: Q&A with pediatric health expert Alan Guttmacher, Countdown to Childx: Stanford expert highlights future of stem cell and gene therapies and Stanford hosts inaugural Childx conference this spring
Photo by Lighttruth

In the News, NIH, Parenting, Pediatrics, Pregnancy, Research

Maternal interaction helps pre-term infants grow, study shows

Maternal interaction helps pre-term infants grow, study shows

new mom with baby

It’s not surprising that interaction with their mothers is helpful to babies who are born prematurely – but new research spotlights some of the specific benefits. Featured in an NIH press release today, a study of a method called H-HOPE (Hospital to Home: Optimizing the Premature Infant’s Environment) found that it correlated with a marked improvement in infant weight gain, length growth, and muscular ability to feed from a bottle.

The H-HOPE program has two parts: First, it teaches mothers to use a multi-sensory intervention that features auditory, tactile, visual, and vestibular stimulation (an “ATVV intervention”), and then it trains mothers to recognize their infants’ subtle communication cues, which are much more discreet than those of term infants. Instead of crying and putting their hand in their mouth to indicate hunger, for example, pre-term babies may weakly lift their hand towards their mouth. The fifteen-minute ATVV intervention, which was administered twice daily before feedings, started with a soft female voice, followed by a gentle massage, eye-to-eye contact, and then rocking-in-arms.

The initial study, published in the Journal of Perinatology, was headed by Rosemary C. White-Traut, PhD, RN, professor emeritus in the department of Women, Children and Family Health Science at the University of Illinois at Chicago College of Nursing. The 183 babies in the study were born between 29 and 34 weeks gestation, and their mothers were involved in the H-HOPE program from the time the baby reached 31 weeks until one month after the approximate date the baby would have been born had the pregnancy reached term. The mothers each received visits from a nurse-community health advocate to make sure the procedures were going smoothly, twice in the hospital and twice after discharge.

Each of the participants had at least two social-environmental risk factors, and half of them were Hispanic, a group with a high rate of prematurity. As White-Traut commented in the release, “When we planned our research, we thought that preterm infants from impoverished backgrounds likely would benefit the most from this intervention. Poverty is linked to poorer long-term health and infant development. And as with other negative health influences, preterm infants usually are affected more strongly than term infants.”

White-Traut’s study showed improved weight gain and growth in the babies; a follow up study (to be published in Advances in Neonatal Care) showed that infants also had better muscular ability to suck from a bottle just after receiving the ATVV intervention, via a sensor placed on the bottle’s nipple while they ate.

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Patient Care, Pregnancy, Stanford News, Women's Health

New obstetric hemorrhage tool kit released today

New obstetric hemorrhage tool kit released today

pregnantbelly-3A few years ago, when my niece was born, my sister had a severe postpartum hemorrhage. I remember getting off the phone with my mom, who had just delivered the simultaneous news of the baby’s birth and my sister’s serious condition, and feeling terrified. My sister was being taken into surgery to try to stop the bleeding. What if she died? In the U.S., deaths from postpartum hemorrhage are rare, but they do happen.

The first thing that gave me a sense of reassurance, strangely, was a search of the medical database PubMed. After I got off the phone, I sat at my laptop looking at a multicolored flow chart that summarized how to stop an obstetric hemorrhage. All of the steps taken by my sister’s medical team were listed. Although she was hundreds of miles away, I felt comforted by the knowledge that her doctors were following well-established, evidence-based guidelines for what to do.

It wasn’t until a few minutes later that I realized the flow chart was developed by doctors I know. It was part of the Obstetric Hemorrhage Toolkit, a set of guidelines published by the California Maternal Quality Care Collaborative (CMQCC). I had first heard of the toolkit from a Stanford obstetric anesthesiologist who helped put it together, but had never imagined it might save someone in my family.

The toolkit was developed because maternal hemorrhages are rare, risky, and extremely time-sensitive. The kit gives medical teams the information they need to rehearse for, recognize and treat these hemorrhages immediately, without wasting minutes that could save the patient’s life.

Today, the CMQCC is releasing a new version of the toolkit. The update strengthens several areas of the kit, providing clearer parameters for use of certain medications and blood products and more information about how to support patients and families after a maternal hemorrhage, for instance.

And the flow chart I found calming is still there, on page 21 of this .pdf file. I’m so happy to see it again because, for me, it symbolizes the doctors, patients and families who will benefit from the kit in the future.

As for my family’s story, my mom called back later on the evening of my niece’s birth to tell me that the bleeding had stopped and my sister was recovering. Her introduction to motherhood was rougher than most, but today my sister and her daughter are fine: My favorite moment of a recent family gathering was seeing my chubby-cheeked niece racing toward me yelling “Aunnnnntie Errrrin!” with my beloved sister in hot pursuit behind her.

Previously: In poorest countries, increase in midwives could save mothers and their babies, Cardiac arrest in pregnancy: New consensus statement addresses CPR for expectant moms and Program focuses on treatment of placental disorders
Photo by bies

Pediatrics, Pregnancy, Stanford News, Surgery

A difficult decision that saved three young lives

A difficult decision that saved three young lives

Estrada-Triplets_013I first met Lily Estrada and her identical triplets almost a year ago. The three babies, who were nearly ready to go home from Lucile Packard Children’s Hospital Stanford, looked pretty ordinary. In fact, that’s why I love the photo at the right, which was taken at the time. Baby Pedro, in blue, was gazing at his mom; Ayden, in orange, was wiggling; and William, in grey, was sucking contentedly on his pacifier.

But they had survived an extraordinarily complicated and rare prenatal disorder. The single placenta that connected all three boys to their mother during pregnancy developed a vascular problem called twin-to-twin transfusion syndrome. Blood flowing through the placenta was not being shared equally between the fetuses, straining their hearts and putting all of them at risk of dying before birth.

When Estrada was diagnosed in late 2013, she and her husband, Guillermo Luevanos, faced a difficult decision. A surgery on the placenta might help save the babies, but it was by no means a sure bet. And, at the time, no one at Stanford performed the procedure, although a new partnership between our maternal-fetal medicine experts and their counterparts at Texas Children’s Hospital, in Houston, provided an opportunity for Estrada to be treated there. In the Stanford Medicine magazine story I wrote about the case, Estrada described how her family felt:

“We were saddened and sort of confused,” Estrada says, recalling the first reactions that she and her husband had to the news. “It was: We could wait and see what happened, but the likelihood was that we were going to have no baby, or we could terminate one and see what happened with the other two, or take the risk, go to Houston, have the surgery and hope it worked for all three. But they didn’t guarantee anything.”

One piece of background that helped inform the couple’s decision was the fact that when the surgery worked, research had shown it helped moms stay pregnant about four weeks longer, allowing their babies more time to develop before birth. (Because the uterus gets so crowded, twins and other multiples are almost always born early, but a less premature delivery makes a huge difference for the babies’ health.) Sealing the connecting blood vessels also seemed to protect surviving fetuses in the event that one died. “We’re separating, or attempting to separate, their fates,” [Estrada’s obstetrician] Yair Blumenfeld, MD, says.

After a lot of counseling and discussion with the Stanford team, “we decided to go for it and do surgery,” Estrada says.

Once they had made the choice, they had no second thoughts. “My husband was a little bit stronger,” Estrada recalls. “He just wanted me to go for it, and see what happened.”

triplets-medresThe surgery, performed at Texas Children’s by Michael Belfort, MD, PhD, was a success. And, as my story describes, the collaboration between the two institutions is going well, too. Stanford researcher Christopher Contag, PhD, and colleagues are studying how to make better and safer surgical tools for future maternal-fetal surgeries, while surgeons here have advanced their capabilities and now offer the surgery for twin-to-twin transfusion here in Palo Alto.

Meanwhile, William, Ayden and Pedro are doing well. My favorite moment in preparing the story was when I got to see our new photo of them, above. As their mom told me, “They’re really happy babies.”

Previously: NIH puts focus on the placenta, the “fascinating” and “least understood” organStanford Medicine magazine reports on time’s intersection with healthPlacenta: the video game and Program focuses on the treatment of placental disorders
Photo of triplets as infants by Norbert von der Groeben; photo of triplets as toddlers by Gregg Segal

In the News, Men's Health, Mental Health, Parenting, Pregnancy, Research

Examining how fathers’ postpartum depression affects toddlers

Examining how fathers' postpartum depression affects toddlers

Zoe walking with GilPostpartum depression doesn’t only affect moms, and new research shows that fathers who suffer from it have just as great an effect on their kids as depressed mothers do. As described in a press release from Northwestern University late last week, toddlers who have a depressed parent of either sex can experience emotional turmoil that manifests both internally and externally, through behaviors such as hitting, sadness, anxiety, lying, and jitteriness.

Most previous studies on the consequences of postpartum depression have focused only on women; this study (subscription required), published in Couple and Family Psychology: Research and Practice, is one of the first to examine how toddlers are affected by depression in either parent. It was led by Sheehan Fisher, PhD, professor of psychiatry at Northwestern University’s Feinberg School of Medicine.

As quoted in the release, Fisher states:

Father’s emotions affect their children. New fathers should be screened and treated for postpartum depression, just as we do for mothers… Early intervention is the key. If we can catch parents with depression earlier and treat them, then there won’t be a continuation of symptoms, and, maybe even as importantly, their child won’t be affected by a parent with depression.

Data for the study was collected from nearly 200 couples; questionnaires were administered both in the first few months after their child’s birth, and when their child was three years old. The forms were completed by each partner independently. Parents who reported signs of postpartum depression soon after the birth of their child also showed these signs three years later – the symptoms didn’t self-resolve. The questionnaire also asked about fighting between parents, which, interestingly, did not contribute to children’s emotionally troubled behaviors as much as having a depressed mother or father did.

Fisher stated in the release that depressed parents may smile and make eye contact less than parents who are not depressed, and that such emotional disengagement may make it hard for the child to form close attachments and healthy emotions.

Previous studies have shown that fathers are at a greater risk of depression after the birth of a child than at any other time in a typical male’s life.

Previously: A telephone lifeline for moms with postpartum depression, 2020 Mom Project promotes awareness of perinatal mood disorders, In study, health professionals helped prevent postpartum depressionDads get postpartum depression too and A call for depression screening for pregnant women, moms
Photo by Michelle Brandt

Imaging, In the News, NIH, Pregnancy, Research, Women's Health

NIH puts focus on the placenta, the “fascinating” and “least understood” organ

NIH puts focus on the placenta, the "fascinating" and "least understood" organ

ultrasoundLast week, the NIH announced its support for an initiative to study how new technologies can shed light on the placenta’s function and health during pregnancy. Considering how crucial the placenta is to not only the health of a woman and her fetus during pregnancy, but also to the lifelong health of both, it’s surprising to hear the NIH call it “the least understood human organ.”

Currently, doctors and scientists can only gather information about the placenta by using ultrasounds and blood tests, and by examining it after delivery. What if new sensors could track how well blood, oxygen, and nutrients are flowing to the fetus, or if new imaging technologies could assess how well the placenta is attaching to the uterine wall? What if biotechnology could assess the effects of environmental factors on the placenta, such as air pollution, maternal diet, and medications?

Better understanding and monitoring of this temporary organ promises to improve maternal and child health. Placental issues can contribute to negative pregnancy outcomes such as preeclampsia, gestational diabetes, preterm birth, and stillbirth, and they’ve also been linked to a higher risk of heart disease later in life, for both mother and child.

This is the third and largest funding announcement for the NIH’s Human Placenta Project, led by the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development and cosponsored by the NIH’s National Institute of Biomedical Imaging and Bioengineering.

Calling the placenta a “fascinating organ” and the “lifeline that gives us our start in the world” Alan E. Guttmacher, MD, director of the NICHHD, also said in an NIH press release:

We hope this funding opportunity will attract a broad range of researchers and clinicians to help — placental biologists, obstetricians, and experts in imaging, bioengineering, and other arenas… For researchers who want to apply their skills in an area of medicine that isn’t being looked at as much as both scientific opportunity and human health warrant, this is a wonderful chance.

Previously: Placenta, the video game, The placenta sacrifices itself to keep baby healthy in case of starvation and Program focuses on the treatment of placental disorders
Related: Too deeply attached and A most mysterious organ
Photo by thinkpanama

Mental Health, Parenting, Pregnancy, Women's Health

A telephone lifeline for moms with postpartum depression

A telephone lifeline for moms with postpartum depression

Van_Gogh_-_Madame_Augustine_Roulin_mit_BabyI’m currently pregnant and due in less than two weeks. It’s my second child, so I’m not as worried about caring for a newborn as I was the first time around. But one nagging worry I have is the risk of postpartum depression, sometimes called postnatal depression. I have a family history of depression and that puts me at higher risk. Luckily, it wasn’t a problem with my firstborn, but it can crop up in later pregnancies – and scientists don’t entirely understand the reasons for it.

Postpartum depression usually hits four to six weeks after delivery—though it can show up months later. It’s characterized by feeling overwhelmed, trapped, guilty or inadequate, along with crying, irritability, problems concentrating, loss of appetite or libido, or sleep problems. An estimated 9 to 16 percent of new mothers are affected by postpartum depression. Even men are known to suffer from it sometimes. PPD affects not just the mother (or father), but can have lasting effects on the child as well, so helping these parents through a difficult and isolating time is critical

Now, a study published in Journal of Advanced Nursing shows that providing a social network for new moms, via phone calls from other mothers who had recovered from PPD, could alleviate symptoms for moms in the study for up to two years after delivery. A news release summarized the findings:

For the present quasi-experimental study, researchers recruited 64 mothers with depression up to two years after delivery who were living in New Brunswick. Peer volunteers who recovered from postnatal depression were trained as peer support and provided an average of nine support calls. The average age of mothers was 26 years, with 77% reporting depressive symptoms prior to pregnancy and 57% having pregnancy complications. There were 16 women (35%) who were taking medication for depression since the birth.

I find the idea that this insidious problem could be tackled with a phone version of the ubiquitous and valuable moms’ groups an uplifting one. Compared to drug treatments, regular phone calls from a peer who’s gone through something similar is a relatively cheap treatment. Further studies are needed, but I’ll be watching to see whether this approach takes hold as a standard intervention for PPD.

Previously: “2020 Mom Project” promotes awareness of perinatal mood disorders,  Is postpartum depression more of an urban problem?, Helping moms emerge from the darkness of postpartum depression, Breastfeeding difficulties may lead to depression in new moms, and Dads get postpartum depression, too
Image by Van Gogh

Cardiovascular Medicine, Pediatrics, Pregnancy, Surgery

Baby with rare heart defect saved by innovative surgery

Baby with rare heart defect saved by innovative surgery

jackson-lane-stanford-childrens560

Elyse Lane was 20-weeks pregnant when she learned that her unborn son had a rare and severe heart defect. Her baby was missing his pulmonary valve and his pulmonary artery was 10 times the normal size.

The outlook was bleak. The baby’s enlarged artery hampered his blood and oxygen flow, a condition called tetralogy of Fallot, and his missing pulmonary valve made the defect worse.

Fortunately, Lane and her husband, Andy Lane, a former Major League Baseball coach with the Chicago Cubs, were referred to Frank Hanley, MD, a cardiothoracic surgeon at Stanford Children’s Health. Hanley had experience with this kind of heart defect and knew how to perform the delicate surgery needed to repair their baby’s heart.

The Lanes recount the story of their son’s lifesaving surgery on the Lucile Packard Children’s Hospital blog:

When he was just five days old, Jackson underwent a 13-hour operation that would save his life. Hanley and his team did a complex overhaul of Jackson’s heart: they inserted a pulmonary valve, reduced the size of Jackson’s right pulmonary artery, and enlarged his small, disconnected, left pulmonary artery. Hanley also used an innovative and intricate procedure known as the LeCompte maneuver, which altered the pathway of Jackson’s right and left pulmonary arteries from the back of the heart and aorta to the front. This gave his severely compromised bronchial tubes room to grow and remodel after surgery was over.

As the story explains, Jackson’s heart will need some maintenance in the future, but he should live a normal and long life.

“He can now do anything he wants in life,” said Elyse Lane in in the blog piece. “He’s already made it through the biggest challenge.”

Previously: Patient is “living to live instead of living to survive,” thanks to heart repair surgery, A very special small package: Three-pound baby receives pacemaker, Advancing heart surgery for the most fragile babies, and Little hearts, big tools
Photo courtesy of Lucile Packard Children’s Hospital

Mental Health, NIH, Pregnancy, Research, Women's Health

Women who have a stillbirth are more likely to experience long-term depression, study shows

Women who have a stillbirth are more likely to experience long-term depression, study shows

5614885964_e75f4261b2_zAny serious loss requires grieving time, and the birth of stillborn child is no exception. However, a recent study suggests that women who have experienced a stillbirth should be monitored for depressive symptoms well after the standard six-month grieving period – up to three years, in fact. Among women who have given birth and who have no history of depression, women who have had a stillbirth are at significantly higher risk of developing long-term depression.

The research was conducted by the NIH’s Stillbirth Collaborate Research Network (SCRN), which defines stillbirth as the death of a baby at or after the 20th week of pregnancy. It occurs in 1 out of 160 pregnancies in the United States, a surprisingly high ratio.

This study is the first to show definitively that women who have no history of depression may face a risk for it many months after a stillbirth

From 2006-2008, the researchers enrolled nearly 800 women from 59 hospitals across the U.S., around a third of whom had delivered a stillbirth (with the other two-thirds having had delivered a healthy baby). In 2009, the women were asked to complete a questionnaire designed to gauge whether they were experiencing symptoms of depression.

After accounting for other factors related to depression and stillbirth among the more than 76 percent of women who did not have a history of depression, the researchers found that women who had a stillbirth were twice as likely to have a high depression score compared to women who had a live birth. This difference was even greater among those responding to the questionnaire 2-3 years after they had delivered, at nearly nine times as likely.

In an NIH article, author Carol Hogue, PhD, director of the Women’s and Children’s Center at Emory University’s Rollins School of Public Health in Atlanta and first author of the study, said, “Earlier studies have found that women with a history of depression are especially vulnerable to persistent depression after a stillbirth, even after the subsequent birth of a healthy child,” but this study is the first to show definitively that women who have no history of depression may face a risk for depression many months after a stillbirth.

The study appears in the March issue of the journal Paediatric and Perinatal Epidemiology.

Previously: 2020 Mom Project promotes awareness of perinatal mood disordersLosing Jules: Breaking the silence around stillbirth, A call to break the silence of stillbirth and Pregnancy loss puts parents’ relationship at risk
Photo by Gates Foundation

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