Published by
Stanford Medicine



Emergency Medicine, Pregnancy, Research, Surgery, Videos

Self-propelled powder moves against blood flow to staunch bleeding in hard-to-reach areas

Self-propelled powder moves against blood flow to staunch bleeding in hard-to-reach areas

If you nick your skin, it’s easy to stop the bleeding by applying a coagulant powder directly to the cut. Yet, bleeding wounds inside the body are beyond the reach of such blood-stopping powders.

Now, Christian Kastrup, PhD, an assistant professor at the University of British Columbia, and a team of researchers, biochemical engineers and emergency physicians, have developed a way to clot internal wounds by creating a self-propelled powder that moves against the flow of blood.

“Bleeding is the number one killer of young people, and maternal death from postpartum hemorrhage can be as high as one in 50 births in low resource settings so these are extreme problems,” Kastrup explained in a UBC press release. “People have developed hundreds of agents that can clot blood but the issue is that it’s hard to push these therapies against severe blood flow, especially far enough upstream to reach the leaking vessels. Here, for the first time, we’ve come up with an agent that can do that.”

To give blood-clotting powder a push, Kastrup and his colleagues added calcium carbonate to the coagulant powder. The carbonate forms porous micro-particles that latch onto the clotting agent (tranexamic acid). As the particles release carbon dioxide gas, fizzing and moving like mini-antacid tablets, they launch the clotting agent toward the source of bleeding.

More rigorous testing and development needs to be done before this agent is ready for use in humans, as the press release and study explain. But it’s possible that in the near future this powder could be used to treat otherwise unreachable cuts such as those in postpartum hemorrhages, sinus operations and internal combat wounds.

Previously: New obstetric hemorrhage tool kit released todayIn poorest countries, increase in midwives could save lives of mothers and their babiesTeen benefited by Stanford surgeon’s passion for trauma care
Video courtesy of UBC

Mental Health, Parenting, Pediatrics, Pregnancy, Public Health, Research, Women's Health

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

2473235415_0584b78298_zSmoking can make it more difficult to get pregnant and it can contribute to complications after conception and endanger the health of babies as they grow. For these reasons, many women quit smoking when they are trying to conceive and during pregnancy. But an estimated 40 percent of women in the United States who kick the nicotine habit for the health of their unborn child relapse within six months after delivery.

New research published in the journal Addiction suggests that the stress of becoming a parent could be a significant factor in why some moms resume smoking after childbirth. In the study, British researchers interviewed 1,000 mothers about factors that influenced their relapse or contributed to them staying smoke-free. Lead researcher Caitlin Notley, PhD, discussed the findings in a PsychCentral article:

One of the most striking things that we found is that women’s beliefs about smoking are a major barrier to remaining smoke-free. Many felt that smoking after the birth of their child was acceptable provided they protected their babies from secondhand smoke.

Their focus is, admirably, on the health of the baby, but they often do not think about the long-term health consequences for themselves as mothers.

We also found that women who saw smoking as a way of coping with stress were more likely to relapse. And that feeling low, lonely, tired, and coping with things like persistent crying were also triggers. Women reported that cravings for nicotine, which had lessened or stopped during pregnancy, returned.

The majority of women who had successfully remained smoke free said that the support of their partner was a strong factor. Partners who gave up smoking, or altered their own smoking behaviors, were a particularly good influence. And those who helped ease the stress of childcare were also praised by women who had resisted the urge to light up

In addition to receiving help from their partners, moms said support from health professionals was another positive contributor to them being able to resist urges to smoke and manage stress.

Previously: Study shows mothers receiving fertility treatments may have an elevated risk of depression, Examining how fathers’ postpartum depression affects toddlers, A telephone lifeline for moms with postpartum depression, What other cultures can teach us about managing postpartum sleep deprivation and Is postpartum depression more of an urban problem?
Photo by Samantha Webber

Genetics, In the News, Pregnancy, Research, Science, Women's Health

Maternal-fetal “chimera” cells: What do they actually do?

Maternal-fetal "chimera" cells: What do they actually do?

1292733380_3e6815a6d1_zAfter a woman is pregnant, fetal cells linger in her body long after her baby is brought out into the world. They cross the placenta and congregate in her thyroid, breasts, brain, scars… and elsewhere. The phenomenon is called “fetal microchimerism,” a reference to the hybrid monster of Greek mythology that strikes me as both whimsical and menacing.

But what do these cells do? An entertaining and informative National Geographic blog post highlights a recent review study published in BioEssays that seeks to answer this question. The evidence we have so far is contradictory and messy, not yielding much in the way of patterns: Sometimes cells collect more in diseased tissues, other times in healthy ones. But when viewed through an evolutionary lens, things start to make sense, argue the paper’s authors. These cells allow a baby to inadvertently influence her mother’s body in her own interest, which is sometimes – but not always – in the mother’s interest, too.

Writer Ed Yong explains:

Some of those changes, like faster healing, benefit the mother too. Others may not. For example, foetal cells could stimulate the breast to make more milk, either by releasing certain chemical signals or by transforming into glandular cells themselves. That’s good for the baby but perhaps not for the mother, given that milk takes a lot of energy to make—mothers literally dissolve their own bodies to create it. And if the foetal cells start dividing too rapidly in the breast, they might increase the risk of cancer.

Similarly, the thyroid gland produces hormones that control body temperature. If foetal cells integrate there and start dividing, they could ramp up a mother’s body heat, to a degree that benefits her baby but also drains valuable energy. And again, if they divide uncontrollably, they might increase the risk of cancer. Indeed, thyroid cancer is one of the only types that’s more common in women than men, but is not a reproductive organ like the ovaries or breasts.

Such influences would have developed gradually over hundreds of millions of years in a subtle evolutionary contest between mother and fetus – it is in the mother’s interest for the fetus to do well, but not to monopolize all her resources, so it’s not unlikely that mothers evolved counter-measures. The paper authors don’t have any conclusions yet, but their point is that within this evolutionary framework, it makes sense that fetal cells both help and harm the mother.

Previous research on microchimerism has only asked about such cells’ presence, not their function. The paper’s authors hope to organize a workshop to test some of the hypotheses they proposed, which means gathering microchimeric fetal cells and sequencing their genes, then working out which of the mother’s genes they are activating and whether these correlate with any traits like milk production or temperature. The possibilities for further research are immense:

And then, there’s the matter of cells that travel in the other direction—from the mother to the foetus. What do they do in their new homes? These paths can get even more complicated. It’s possible that the cells from one foetus can travel into its mother, hide out, and then into a sibling during a later pregnancy. “At one point, we started trying to draw family trees, and trying to work out where all the microchimerc cells could be going,” says [co-author Athena Aktipis, PhD]. “It got really messy.”

Previously: How a child’s cells may affect a mother’s long term health
Related: The yin-yang factor
Photo by Simone Tagliaferri

In the News, Parenting, Patient Care, Pregnancy, Public Health, Women's Health

Low-tech yet essential: Why parents are vital members of care teams for premature babies

Low-tech yet essential: Why parents are vital members of care teams for premature babies

3297657033_081d4f3630_zThanks to recent advances in medicine, technology and research, most premature babies born in the United States face better odds of surviving than ever before. Yet, the number of premature births in the U.S. remains relatively high, with a rate that’s on par with that of Somalia, Thailand and Turkey.

For the parents of a premature baby, an early birth can transform what was supposed to be a happy event into a stressful one, says Henry Lee, MD, an assistant professor of pediatrics at Lucile Packard Children’s Hospital Stanford. In a recent U.S. News & World Report article penned by Lee, he discusses why it’s important for parents, and beneficial for the baby, when parents are active members of the child’s medical team:

Giving birth to a preemie, especially when it’s unexpected, leaves many parents feeling unprepared and helpless. But we make it clear very early. “You, the parent, are a critical part of our medical team.” That’s right. Even in the heart of Silicon Valley where we’re located, two of our biggest assets are decidedly low-tech workers: the baby’s mom and dad.

Including parents in the care of preemies is a standard that was unheard of in the early days of neonatology, but is now used in leading NICUs for one critical reason: It works.

Here’s an example of how parents contribute. Studies have shown that skin-to-skin care, also known as kangaroo care, can have beneficial effects on preterm neonates, including improved temperature and heart rate stability. In many NICUs, you will see babies – clad only in a diaper and covered by a blanket – placed prone position on the chest of either the mother or the father. This intimate method of care provides a preterm baby a natural environment for rest, growth and healing.

No matter when a baby is born, term or preterm, families know their children best. A parent’s contribution is critical to treating these most vulnerable of newborns.

Previously: How Stanford researchers are working to understand the complexities of preterm birthNew research center aims to understand premature birth and A look at the world’s smallest preterm babies
Photo by Sarah Hopkins

In the News, Media, Medical Education, Medicine and Society, Myths, Pregnancy, Research

Reality TV influences perspectives on pregnancy, study shows

Reality TV influences perspectives on pregnancy, study shows

272417047_806faa2243_zA new University of Cincinnati study on the influence that television programs have on pregnant women has found that most women are more affected by TV representations of childbirth than they think.

The study, funded by the NSF and conducted by Danielle Bessett, PhD, assistant professor of sociology, followed a diverse group of 64 women over the course of two years and investigated how they understood their television viewing practices related to pregnancy and birth. It found that class, as measured by education level, had the greatest influence on whether a woman acknowledged television as a significant source of pregnancy-related information. Highly educated women and those who worked outside the home were more likely to dismiss TV, while those with less education and who were unemployed or took care of children at home were more likely to report watching and learning from such shows as TLC’s “Baby Story” and “Maternity Ward” and Discovery Health’s “Birth Day.”

The particularly interesting finding is that TV portrayals affect women’s perceptions even when they don’t believe they have an influence. Bessett developed the term “cultural mythologies of pregnancy” to describe how TV, film, media, and word of mouth create expectations about “the way things are.” Most reality TV and fictionalized programming presents childbirth as more dramatic and full of medical interventions than the majority of births really are, and these images made a lasting impression on women.

As quoted in the press release, Bessett says, “Hearing women –– even women who said TV had no influence on them –– trace their expectations back to specific television episodes is one of the few ways that we can see the power of these mythologies.” Many women mentioned pregnancy representations they had seen long before they got pregnant.

Women who reported watching TV considered it part of a comprehensive childbirth education program and would often evaluate the programs’ reliability, while women who disavowed television saw it as entertainment or education for children, likely from a desire to be seen as valuing science and medical expertise.

“If we believe that television works most insidiously or effectively on people when they don’t realize that it has power, then we can actually argue that the more highly educated women who were the most likely to say that television really didn’t have any effect on them, may in the end actually be more subject to the power of television than were women who saw television as an opportunity to learn about birth and recognized TV’s influence,” hypothesizes Bessett.

“This research implies that many women underestimate or under-report the extent to which their expectations of pregnancy and birth are shaped by popular media,” concludes Bessett, suggesting that “scholars must not only focus on patients’ professed methods for seeking information, but also explore the unrecognized role that television plays in their lives.”

Previously: New reality shows shine harsh light on teen pregnancy and Study: TV dramas can influence birth control use
Photo by johnny_zebra

Mental Health, Pregnancy, Research, Women's Health

Study shows mothers receiving fertility treatments may have an elevated risk of depression

Study shows mothers receiving fertility treatments may have an elevated risk of depression

5088785288_9f7a23f17a_zAn estimated one in four couples in developing countries encounter difficulties trying to conceive. In the United States, more than 7 million women have undergone fertility treatments and, as a result, millions of babies have been born through in-vitro fertilization.

While many may assume that failed fertility treatments would increase a woman’s risk of depression more than successful attempts that resulted in a live birth, research recently published in the journal ACTA Obstetricia et Gynecologica Scandinavica shows that the opposite may be true.

In the study, researchers from the University of Copenhagen analyzed data on 41,000 Danish women who had undergone fertility treatments. PsychCentral reports that “investigators discovered women who give birth after receiving fertility treatment are five times more likely to develop depression compared to women who don’t give birth.”

Lead author Camilla Sandal Sejbaek, PhD, discusses the results in the story:

The new results are surprising because we had assumed it was actually quite the opposite. However, our study clearly shows that women who become mothers following fertility treatment have an increased risk of developing depression in the first six weeks after birth compared to women who did not have a child.

Our study has not looked at why the depression occurs, but other studies indicate that it could be caused by hormonal changes or mental factors, but we cannot say for sure. We did not find any correlation between the number of fertility treatments and the subsequent risk of depression.

Previously: Stanford-developed fertility treatment deemed a “top medical breakthrough” of the year, Ask Stanford Med: Expert in reproductive medicine responds to questions on infertility, Image of the Week: Baby born after mom receives Stanford-developed fertility treatment and NIH study suggests progestin in infertility treatment for women with PCOS may be counterproductive
Photo by Big D2112

Microbiology, Pregnancy, Research, Stanford News

Stanford microbiome research offers new clues to the mystery of preterm birth

Stanford microbiome research offers new clues to the mystery of preterm birth

preemie-holdinghandsPremature birth affects 450,000 U.S. babies each year and is the leading cause of newborn deaths. But in about half of cases, doctors never figure out what triggered premature labor in the pregnant mom.

Now, there’s a new clue: A Stanford study, published today, gives important details of how the microbiome – the body’s community of bacteria – behaves in women whose pregnancies go to the full 40-week term, and what’s different in women whose babies come three weeks, or more, early. A specific pattern of vaginal bacteria was linked to greater risk of preterm delivery, and the longer the pattern persisted, the greater the risk, the study found.

The work is one piece of a larger effort by the March of Dimes Prematurity Research Center at Stanford to bring experts from many branches of science together to work on preterm birth. The researchers collected weekly bacterial samples throughout pregnancy from four body sites for 49 pregnant women, of whom 15 delivered prematurely. Patterns of vaginal bacteria that were dominated by lactobacillus bacteria were linked to low prematurity risk. Such patterns had already been shown to be linked to health in non-pregnant women.

A pattern of high bacterial diversity, low lactobacillus and high levels of gardnerella and ureaplasma bacteria was linked to higher prematurity risk, the study also showed. This was especially true if the high-diversity pattern persisted for several weeks. From our press release about the new research:

“I think our data suggest that if the microbiome plays a role in premature birth, it may be something that is long in the making,” said the study’s lead author, Daniel DiGiulio, MD, a research associate and clinical instructor in medicine. “It may be that an event in the first trimester or early second trimester, or even prior to pregnancy, starts the clock ticking.”

The researchers also followed the women’s bacterial communities for up to a year after their deliveries and found that all new mothers shifted to the high-risk pattern, regardless of if their babies were born early or on time or if they had a c-section or vaginal delivery. This finding may help explain why women with closely-spaced pregnancies are more likely to have a preterm baby the second time around, however more work is needed to better understand this discovery, concluded researchers.

Ultimately, the research team hopes to use their findings to develop interventions that could prevent preterm birth. That would definitely be good news for moms and babies.

Previously: Counseling parents of the earliest-born preemies: A mom and two physicians talk about the challenges, Stanford/VA study finds link between PTSD and premature birth and Maternal obesity linked to earliest premature births, says Stanford study
Photo by bradleyolin

Patient Care, Pregnancy, Women's Health

“The Mama Sherpas”: Exploring the work of nurse-midwives and their collaborations with doctors

"The Mama Sherpas": Exploring the work of nurse-midwives and their collaborations with doctors

baby feetAs a doula, I’m pretty tapped into the birth community, and I’ve definitely noticed a trend toward midwifery care and low-intervention births. Indeed, a 2012 study showed that more babies than ever before are being delivered by midwives.

Now, a new film is documenting how midwives and obstetricians are increasingly teaming up to offer great maternity care. “The Mama Sherpas,” directed by Brigid Maher and produced by Ricki Lake and Abby Epstein (the same people behind the well-known “The Business of Being Born“), showcases the growing popularity of Certified Nurse Midwives (CNMs) in hospital births.

CNMs are registered nurses who have a master’s degree in midwifery and who adhere to the “woman-centered” Midwives Model of Care. According to the film, collaborative care between CNMs and obstetricians can lead to decreased C-section rates, increased VBAC rates (vaginal birth after cesarean), far lower health-care costs, and mothers who are more satisfied with their birth experience.

I had the chance to attend an advance screening, sponsored by the Nurse-Midwives of Monterey Bay, last week, and I was particularly impressed by the footage of the births of the women chronicled. While highly graphic, it provided beautiful portraits of calm and powerful vaginal births, a life-saving caesarian, and even a vaginal breech birth – which I and many in the audience of birth workers had never seen before! Afterwards, the panel of CNMs and obstetricians from hospitals in Santa Cruz and Davis called for more obstetricians to be trained in vaginal delivery of breech births, and in turning breech babies by performing external versions, so that those options can be offered to women.

Previously: In poorest countries, increase in midwives could save lives of mothers and their babiesA reminder that prenatal care is key to a healthy pregnancyUnneeded cesareans are risky and expensive and Tensions high in debate over safety of home births
Photo by Bridget Colla

Chronic Disease, Neuroscience, Pregnancy, Research, Women's Health

Women with epilepsy face elevated risk of death during pregnancy and childbirth – but why?

Women with epilepsy face elevated risk of death during pregnancy and childbirth - but why?

5987537049_ed5eff3b31_zWomen with epilepsy face a higher risk of death and a host of complications during their pregnancies than other women, according to a new study published today in the Journal of the American Medical Association Neurology.

The researchers found women with epilepsy had a risk of 80 deaths per 100,000 pregnancies, more than 10 times higher than the risk of 6 deaths per 100,000 pregnancies faced by other women.

That’s a big deal, neurologists Jacqueline French, MD, from NYU Langone Medical Center, and Stanford’s Kimford Meador, MD, write in an accompanying editorial.

“The study should sound a major alarm among physicians and researchers,” French and Meador write. But, it fails to answer an integral question, they say: Who exactly is at risk and why did the women die?

Women with epilepsy are more likely to have hypertension, diabetes and a variety of psychiatric conditions. Are those conditions responsible for the differences in death rates, the authors question.

The study also fails to distinguish between women with well-controlled epilepsy and those continuing to suffer seizures. “These are critical questions, and, without the answers, we are left in the unsatisfying position of having to advise all women with epilepsy that they may be at higher risk,” French and Meador write. The study “raises far more questions than it answers. Most women with epilepsy have uncomplicated pregnancies.”

The authors conclude: “Future studies need to confirm and build on the present findings to improve the care of women with epilepsy during pregnancy.”

Previously: Treating intractible epilepsy, Ask Stanford Med: Neurologist taking questions on drug-resistant epilepsy and How epilepsy patients are teaching Stanford scientists more about the brain
Photo by José Manuel Ríos Valiente

Behavioral Science, In the News, Medicine and Society, Pregnancy, Public Health

Walking on sunshine: How to celebrate summer safely


Normally, I spend the Fourth of July on the shores of a Wisconsin lake, getting eaten alive by mosquitos, burning to a bright shade of pink, lighting sparklers and eating potato salad that has sat in the sun for hours. Heaps of fun, but also plenty of opportunities to fall ill.

This year, I’ve been barred from that fun trip by my oh-so-practical doc, who thinks unnecessary travel isn’t the smartest option for someone who is eight-months pregnant. Instead, I’ll have to be satisfied with reading a Washington Post article, published earlier this week, about all the summer health hazards I’m avoiding by celebrating the holiday in my coastal California home.

First is athlete’s foot, a fungus that “lingers on warm, wet surfaces such as poolside pavement and the floors of locker rooms and public showers” that produces an oozing pus. Or its relative, a toenail fungus that leads to yellow, thickened nails. And I thought a big belly was a bit of bother.

There’s also coxsackie virus, known for causing hand, foot and mouth disease, which thrives in kids’ wading pools courtesy of the occasional leaky diaper. The virus usually causes blisters; in rare cases it can lead to heart failure, says Stanford pediatrics professor Bonnie Maldonado, MD. Note to self: Keep baby out of unchlorinated kiddie pools.

We’re just getting warmed up here. There’s the summertime regulars of food poisoning, heat exhaustion and heat stroke. So yeah, that potato salad, while still yummy, probably isn’t a good idea, nor is the all-afternoon exposure to 95-plus degrees.

Don’t forget swimmer’s ear, an infection of the ear canal that, according to otolaryngologist Richard Rosenfeld, MD, from New York can “really, really, really hurt and ruin a vacation.” And a walk in the woods can quickly yield a ravaging rash from poison ivy or oak.

Throw in insect-borne plagues like West Nile and Lyme disease and gee, I guess my front porch isn’t looking so bad after all.

Previously: As summer heats up, take steps to protect your skin, This summer’s Stanford Medicine magazine shows some skin and Stanford nutrition expert offers tips for a healthy and happy Fourth of July
Photo by Jordan Richmond

Stanford Medicine Resources: