Tiny survivor has a real fighting spirit

Carsyn Grayce Wolford turns five months old. The day will represent yet one more milestone in the short life of the preemie born March 8 at St. Peter's Hospital.
At birth she weighed 15 ounces; less than one pound and measured just 10 inches. Her survival is nothing less than a miracle, according to Austyn Wolford, her mother. And her doctors agree.
Carsyn is the smallest baby to ever have survived at St. Peter's, weighing in at just 429 grams at birth. Her original due date was June 15 but because Austyn suffered in early March from pre-eclampsia (or pregnancy-related hypertension) and a placental disruption (when the placenta separates from the wall of the uterus prematurely) an emergency caesarean had to be performed.
Before Carsyn's birth, the smallest baby to survive at St. Peter's was born December 2004 at 23 weeks gestation (three weeks sooner than Carsyn), weighing 15.4 ounces.
Survival of babies weighing over 500 grams (more than one pound) is pretty commonplace, but for those that weigh less than 500 grams, survival to this point is rare, said physician Karen Narkewicz, chief of Neonatology at St. Peter's.
"She was strong and feisty, right from the start. ... Of the 75 to 80 percent of these babies that do survive, most have major problems. Carsyn does not appear to have any major problems. She will have challenges with gaining weight. ... Developmentally, she has met all of the milestones and is doing great," she said.
Carsyn is going home today after three and one-half months in the hospital's Neonatal Intensive Care Unit. She is now 18 inches long and weighs five pounds and five ounces.
"She's huge," said Austyn Tuesday afternoon, cradling the wriggling baby in her arms while mom and daughter posed for photographers and reporters.
At just over five pounds the infant even appeared large to Jackie Repscher, the nurse who has been at her side since the birth.
It's hard to believe that a tiny pair of leather moccasins no larger than 1 ½ inches each actually fit Carsyn's feet a few days after she was born. Now her feet are twice that size, Austyn said.
Merely holding her baby in her arms is something she cherishes.
The young mother has gotten used to the waiting game. She wasn't able to see her baby until a day after her birth. At the time her skin was transparent and her eyes had not yet opened
Austyn went home March 12, four days after the birth, and then began daily trips to the NICU to visit her child.
"I couldn't do anything except sometimes hold her hand, for seven weeks. I couldn't change a diaper or hold her. It was very difficult, but she was a fighter," she said.
The process has been an emotional rollercoaster ride.
"It's been a 138-day adventure. No one is ever prepared for something like this. No one ever thinks it's going to happen to them," she said.
At 27, she is a first-time mom and a medical billing specialist at Julie Blair Nursing Home in Albany. She plans on being the child's primary caregiver, but will move back to Stoneridge, Ulster County to live with her parents so they, too, can be an active part of the care-giving circle.
As a newborn, Carsyn faced a number of complications, Narkewicz said.
"She was small for her gestational weight. Her liver was very large at birth and her lungs were about the size of a postage stamp, which made it difficult to put her on a ventilator. ... Early on, she had a hole in her intestine but was too small to undergo surgery. She eventually underwent three surgeries and had to be fed through an IV," she said.
Challenges still lie ahead for the infant who has been nicknamed Sarah Bernhardt, after the 19th Century Parisian actress because of her apparent flair for the dramatic. But her doctors are confident that she'll continue to thrive and her mom plans to be there every step of the way.
"I never thought I could love something so much," Austyn said.

Source:www.troyrecord.com

Unborn babies at risk from weight change by mothers

Mothers who drastically lose or gain weight between pregnancies could damage the health of their unborn babies, according to medical experts.

They say women are becoming increasingly pressurised after being "bombarded" with messages about body image, ranging from the "size zero" culture to fears about obesity.

However, they warn women whose weight fluctuates dramatically before becoming pregnant again could be putting their own health, and that of the child, at risk.
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Writing an editorial published today in the British Medical Journal, Dr Jennifer Walsh and Professor Deirdre Murphy, pointed to two separate studies on weight gain and loss between pregnancies.

They showed gaining weight could cause high blood pressure and diabetes in mothers and could also cause problems during childbirth, with a greater risk of forceps delivery, caesarean sections and an increased risk of stillbirths.

However, they also warned losing large amounts of weight very rapidly could cause premature births.

"Women of reproductive age are bombarded with messages about diet, weight and body image," they said. "There is growing concern on the one hand about an epidemic of obesity and on the other about a culture that promotes size zero' as desirable, irrespective of a woman's natural build.

"Pregnancy is one of the most nutritionally demanding periods of a woman's life, with an adequate supply of nutrients essential to support foetal wellbeing and growth.

"With at least half of all pregnancies unplanned, women need to be aware of the implications of their weight for pregnancy, birth and the health of their babies.

"However, the potential to provide women with conflicting information about weight, weight gain and weight loss extends to pregnancy and birth outcomes."

One study from Sweden, which examined 207,534 women, found increased rates of pre-eclampsia, high blood pressure and diabetes in the mothers whose body mass index (BMI) increased by one to two units between preg-nancies. A rise of more than three BMI units significantly increased the rate of stillbirths.

The second study found women whose BMI fell by five or more units between pregnancies had a higher risk of giving birth prematurely than those whose weight remained stable or increased.

Professor Murphy, professor of obstetrics at Trinity College, University of Dublin, said "swinging changes" in weight were harmful to both mothers and babies and women should try to maintain a healthy weight before, during and after pregnancy. She said women should also ignore pressure from celebrity mothers, many of whom are seen squeezing back into their pre-pregnancy clothes within weeks of giving birth.

"The issue is both for mother and baby," she said. "Most people realise being very overweight is bad for your health but some women don't realise being underweight causes problems with pregnancy.

"The health message is to try to be a normal weight for you and maintain a normal weight - neither going underweight, which some of these celebrities are, nor becoming relaxed about the fact you have put a lot of weight on.

"The important thing is to lose weight steadily so it is something you can maintain throughout your life, not just in the short term." She added it was important that healthcare professionals were able to advise women on the best way to protect their own and their children's health.

Gillian Smith, acting director of the Royal College of Midwives in Scotland, said it was important all agencies worked together to give the best advice. She added: "There has been huge publicity about obesity and the damage that causes but it is also about making sure a woman's low weight does not cause damage."

Source:www.theherald.co.uk

Too posh to push mums hike up Caesarian rates

EXPECTANT mothers who are "too posh to push" have helped to almost double the rate of Caesarean births in Edinburgh.

Last year, more than one in four women who gave birth in the Capital had Caesarean sections to deliver their babies - higher than the UK and Scottish average, and up from 16 per cent in 1995.

There were 1647 Caesarean births at the Simpson maternity centre last year - 27 per cent of all births.

Midwives said one of the reasons for the rise was "a class of women" in the city who choose pre-planned Caesareans for non-medical reasons.

Other explanations include more professional women who give birth later in life, and the large number of high-risk births from all over south-east Scotland that are handled in Edinburgh.

And as the number of first Caesareans grows, so too does the repeat rate, as women who have had one surgical birth are more likely to have another.

Medical experts today said the rate was "undoubtedly too high" and questioned whether Caesareans were being done as a matter of course.

Gillian Smith, acting director for RCM Scotland, said: "There is no doubt that a 27 per cent Caesarean section rate is high. Some places get it below 20 per cent. It is a fallacy to purport that Caesareans are a safe option - there are risks associated with major abdominal operations."

Edinburgh-based Cynthia Clarkson, maternity services convener with the National Childbirth Trust, added:

"The World Health Organisation (WHO) said the rate should not exceed 15 per cent.

We need to look carefully at individual cases and decide if Caesareans are really beneficial."

The national average rate in 2005 was 24.9 per cent. At St John's Hospital in Livingston, there has been a steady year-on-year rise to 26 per cent in 2006.

In 2000, the former Simpson Memorial Maternity Pavilion in the city had a rate of 22.4 per cent, and just 16 per cent in 1995.

In the most recent figures, just over one third were elective - or unplanned - Caesareans, usually for medical reasons but sometimes by personal choice.

Dr Rhona Hughes, lead obstetrician with NHS Lothian, said: "A Caesarean section is only carried out when there is a clinical need. We always prefer to see a natural birth and we are proactively trying to encourage that.

"Senior midwives are also involved in a scheme to help and support mothers who have previously had a Caesarean section, to enable them to have natural births in subsequent pregnancies.

"Edinburgh's figures may be higher than the Scottish average for a number of reasons, including the fact our mothers are generally older than elsewhere in the country, we receive problematic pregnancies from all over the south-east of Scotland and we have an IVF service which tends to produce more twins and, therefore, increases the need for Caesarean section."
'I didn't want surgery but my baby was in distress'

NEW mother Louise Cumming was adamant she did not want a Caesarean birth.

But when the 33-year-old housewife was told that her unborn baby was in distress, she reluctantly agreed to go ahead with the emergency operation.

Mrs Cumming, from Mitchell Street in Leith, is still unsure if the decision was necessary.

She also fears she may be required to undergo an elective Caesarean in the future if she wants more children.

Daughter Emily is now nearly 21 months old, and in perfect health.

"I went to the ERI to be induced because I was showing symptoms of pre-eclampsia and my blood pressure was high," she said.

"On the Friday, I was told my baby was in distress so I had an emergency Caesarean. I was adamant I did not want a Caesarean birth, but I had had little sleep and was exhausted so I gave in.

"We live in a fourth floor flat, and for six weeks after the birth I was stuck inside recuperating.

"I hope it was the right decision to make, but you never know. Afterwards, my GP said my daughter may have come out on her own if left a bit longer, but there's no way of knowing."
NHS hails healthy rise in nursing staff

AN extra 390 nurses have been employed to work on Lothian hospital wards following a successful recruitment drive.

In the past two years, new figures show NHS Lothian has moved from having the highest to one of the lower vacancy levels in Scotland.

Currently the board employs 9268 full-time registered and unregistered nurses, up from 8876 at the same point in 2005.

Health chiefs have also dramatically cut the amount paid to nursing agencies from £11 million in 2003/04 to £4m in the most recent financial year, with the efficiency savings ploughed back into patient care.

Heather Tierney-Moore, NHS Lothian director of nursing, said: "The recruitment drive has been a great success. Nurses are increasingly attracted to Lothian because it is a flexible employer with family friendly policies, and is recognised as a centre of excellence."

The board has also developed a bank of experienced nurses, who are able to provide cover for holidays and sickness.

Source:news.scotsman.com

Weight change 'harms pregnancy'

Women who lose or gain weight between pregnancies could be putting their unborn babies' health at risk, doctors warn today.

Two senior obstetricians, Dr Jennifer Walsh and Professor Deirdre Murphy, argue that fluctuating weight can have major health implications for the baby.

Writing in the British Medical Journal (BMJ), they outline the findings from a Swedish study relating to weight gain between pregnancies.

The researchers studied 207,534 women from the beginning of their first pregnancy to the beginning of their second.

They found that if a woman's body mass index (BMI) increased by just one to two units her risk of pre-eclampsia, diabetes and pregnancy-induced blood pressure increased. The baby was also more likely to have a high birth weight.

A rise of more than three BMI units significantly increased the rate of stillbirths.

Dr Walsh and Professor Murphy write that the findings show women of normal weight should avoid gaining weight between pregnancies and overweight or obese women could benefit from weight loss before becoming pregnant.

The second study found that women whose BMI fell by five or more units between pregnancies had a higher risk of giving birth prematurely than women whose weight remained stable or increased.

This risk was significantly higher (80 per cent) for women who had already had a premature birth than those who had not (28 per cent).

"Women are at increased risk of different but equally serious adverse pregnancy outcomes if they gain or lose an excessive amount of weight between pregnancies," Dr Walsh and Professor Murphy write.

"Although apparently conflicting, these studies show how important it is to attain and maintain a normal healthy weight before, during, and after pregnancy."


Source:www.inthenews.co.uk

Danger of losing too much weight after giving birth

Mothers who lose too much weight quickly after giving birth could be putting their next baby at risk, doctors have warned.

On the other hand, gaining too much weight after a pregnancy can be just as dangerous.

Any rapid weight changes between pregnancies can increase the risk of babies suffering high blood pressure, along with the prospect of premature or stillbirth.

The warning comes from two studies highlighted yesterday by the British Medical Journal.

The researchers, from Coombe Women's Hospital, Dublin, urged women to maintain a healthy weight before, during and after pregnancy to give their children the best start in life.

Many women struggle to lose the extra weight they gain during pregnancy, despite following advice to exercise, eat healthily and breast feed where possible.

Source:www.dailymail.co.uk

Risks of Complications are Higher in ART Than in Natural Conception

The risks of complications both during and after pregnancy achieved through assisted reproduction techniques (ART) are significantly higher than for natural conception, and long term follow-up of children born through ART is needed to fully understand the consequences of these techniques. The issues are addressed in a Review published in this week's edition of The Lancet.


Dr Alastair Sutcliffe, Institute of Child Health, University College London, UK and Dr Michael Ludwig, Endokrinologikum, Hamburg, Germany reviewed data published between 1980 and 2005 on in-vitro fertilisation (IVF) and intracytoplasmic sperm injection, and used 3980 articles to compile their analysis. They focussed mainly on ART single births, since multiple births bring with them their own set of confounding complications.

The authors say: “In-vitro fertilisation has been done for nearly 30 years; in developed countries at least 1% of births are from ARTs. These children now represent a substantial portion of the population but little is known about their health."

They say that there are several points for consideration when counselling couples seeking treatment for subfertility. The biggest risk for ART is that multiple births may occur, however a number of other risks are evident from ART techniques.

Spontaneous abortion rates are between 20-34% higher for ART couples compared to those spontaneously conceiving -- this could be because ART couples are generally older, and also due to endocrine disorders, organic abnormalities and the degree of ovarian stimulation. For couples using ART, the risk of pre-eclampsia occurring is increased by 55%, while there is also an increased risk of still birth (155%), low birthweight (70-77%) very low birthweight (170-200%), or the baby being small for gestational age (40-60% increased risk).

Source:www.medindia.net

With the ACLU's help in 1995, Kevin Knussman sued his employer, the Maryland State Police, to get family leave to care for his ailing wife, Kim (right

Kevin Knussman arrived home in January 1995 at 3:30 a.m. from a night shift to the sound of his newborn daughter, Paige, wailing.

The Maryland State Police paramedic from Easton rushed to her and found his wife, Kim, in the same room, so overcome with exhaustion that she didn't hear Paige's cries.

Kim was suffering from pre-eclampsia, a disorder that occurs during pregnancy and postpartum. Symptoms include high blood pressure, headaches and changes in vision. Clearly, both mother and baby needed Knussman to stay home and be the family's primary caregiver.
When he asked for extended leave, the state police denied the request, even though a federal law had recently been passed giving all workers up to 12 weeks of unpaid parental leave. A Maryland law also allowed "primary care providers" up to 30 days of paid leave after the birth or adoption of a baby.

The police gave Knussman 10 leave days and said that if he took another day off he would be declared absent without leave. Stuck between the cares of home and the demands of work, Knussman didn't take another day off.

Instead, he took his employer to court.

His case was among the first gender-discrimination cases filed under the 1993 Family and Medical Leave Act, which at the time was viewed as a protection for women who need time off after the birth or adoption of a child.

"He didn't fit the stereotype of what people may have thought the law was about," said Jocelyn Frye, general counsel for the National Partnership for Women and Families. "His case put a face on the [FMLA] and made it a family issue."

Knussman became known as Trooper Dad. By the time the 1995 ACLU-assisted lawsuit went to trial in 1999, Paige was almost 5.

Three years later, Knussman was awarded $40,000 for emotional distress and an undisclosed six-figure amount in attorney's fees. To Knussman's supporters, equally important as the money was the fact that the case illustrated that the FMLA could not be ignored.

"It shows employers have to take these laws seriously," said Laura Kessler, an associate law professor at the University of Utah.

The man who spent 23 years as a state trooper, mostly as a helicopter paramedic, has since retired. Paige, now a preteen, recently won a contest to be an honorary batgirl during an Orioles game. His wife recovered long ago from her ailment. And the Knussmans had no family-leave worries when their now-10-year-old daughter, Hope, was born.

As he looks back on his battle, Knussman acknowledges mixed emotions. "I wouldn't condemn anyone else for not going through it," he said. "It's hard to fight the state, the government, because they have unlimited resources."

Knussman, who now works as a paramedic seven days a month, relishes the nationwide support he received. He still receives e-mails from people seeking to challenge employers for family leave permission.

Source:www.baltimoresun.com

More Health Risks Found in IVF Babies - Scientist Suggests IVF Children Should be Monitored into Adulthood

A study of 3,980 articles in medical and scientific journals between 1980 and 2005 has shown significantly higher risks of long-term medical problems for children conceived through artificial procreation such as in vitro fertilisation or intracytoplasmic sperm injection, a method in which a selected sperm is injected into the ovum.

Dr. Alastair Sutcliffe, of the Institute of Child Health at University College London and Dr. Michael Ludwig, of the Centre for Reproductive Medicine and Gynaecologic Endocrinology in Hamburg, examined the data and have concluded that babies conceived through artificial means should be monitored well into adulthood.

The study showed the risk of miscarriage is between 20 and 34 per cent higher than naturally conceived children. It showed 55 per cent increase in the risk of pre-eclampsia, or hypertension in pregnancy; an increased risk of stillbirth at 155 per cent; low birth weight at 70 to 77 per cent and very low birth weight at 170 to 200 per cent.

Major malformations and cerebral palsy are also significantly more likely with artificially conceived children.

Dr Sutcliffe commented, “In-vitro fertilisation has been done for nearly 30 years; in developed countries at least 1% of births are from ARTs [assisted reproduction techniques]. These children now represent a substantial portion of the population but little is known about their health.”

The study coincides with numerous others showing that IVF and related fertility technologies produce significantly higher rates of serious health problems in children.

Most recently, a study published in the June 21, 2007 issue of Human Reproduction showed that children conceived through IVF visit hospitals significantly more times (1.76 vs. 1.07 times) than naturally conceived children.

Source:www.lifesite.net

Weight Gain or Weight Loss Can Affect Unborn Baby

Gaining or losing weight in between pregnancies can have major health implications for an unborn baby, warn two senior obstetricians in the British Medical Journal in an editorial.

While weight and obesity have long concerned women in relation to body image and lifestyle issues, few are aware of the possible risks that fluctuating weight could have on their unborn child, write Dr Jennifer Walsh and Professor Deirdre Murphy.

They point to two studies. The first, from Sweden, which found that weight gain between pregnancies was strongly associated with major complications for the woman and baby in the months preceding, during and just after childbirth. This was independent of whether a woman was, by definition, overweight.

The researchers studied 207,534 women from the beginning of their first pregnancy to the beginning of their second. They found increased rates of pre-eclampsia, diabetes in the expectant mother, pregnancy induced high blood pressure and high birth weight if a woman's body mass index (BMI) increased by just one to two units. A rise of more than three BMI units significantly increased the rate of stillbirths.

The key message, say the authors, is that women of normal weight should avoid gaining weight between pregnancies, while overweight and obese women are likely to benefit from weight loss before becoming pregnant.

The second study looked at whether a change in the mother's nutritional balance increased the risk of a premature birth. They found that women whose BMI fell by five or more units between pregnancies had a higher risk of giving birth prematurely than women whose weight remained stable or increased. The risk was significantly higher for women who had already had a premature birth (80% versus 28%).

"Although apparently conflicting, these studies show how important it is to attain and maintain a normal healthy weight before, during, and after pregnancy," say the authors.

Most women want to achieve the best start in life for their babies, they add. This could be a powerful motivational factor in helping them change the way they eat.

Source:www.sciencedaily.com

Mums warned over post-pregnancy weight

MOTHERS who gain or lose lots of weight between pregnancies could be putting their baby at risk, experts warn today.

The trend for new mothers to try to copy celebrity role models and lose lots of weight in a short amount of time could be detrimental to their child’s health. But women who pile on the pounds after giving birth also put their next child at risk, they said.

Effects can include premature birth, greater risk of stillbirth and high blood pressure.

Doctors and midwives say that women should try to maintain their “optimum” – or stable – weight before, during and after pregnancy to give their child the best start in life.

Helen Rogers, head of the Royal College of Midwives in Wales, said, “Women see so-called celebrities who lose two stone in a month and they look amazing but they forget that these people have personal trainers and nannies and nothing else to do except get back into shape, which is their job.

Source:icwales.icnetwork.co.uk

Stop the carnage on women and children

The reality of the pervading maternal and infant mortality dawned on me last week when I went home for the burial ceremony of one of my relations. A woman in her early thirties, a widow and mother of four reportedly died while bringing to the world the next child.

Prior to this, she was said to be suffering from pregnancy-induced hypertension (pre-eclampsia). Medical attention was sought when it became very late for obvious reasons bordering on poverty, low level of education and attitude to issues of maternal and child health especially in a rural setting.

The death of the woman and subsequently her unborn child is one story that has become a common feature of the Nigerian health situation for some time now. Year in year out, the statistics keeps coming and reminding us of the grim nature of the problem which appears to be abetting at a low pace in some areas while alarmingly increasing in some others.

Over time, Nigerian government and its health authorities have vowed to reduce drastically the high incidence of morbidity especially in pregnant women and infants. They have emotionally sounded the unacceptability of women dying in hundreds while bringing forth babies into the Nigerian world. They have theoretically mapped out programmes in primary health care to help checkmate this problem.
But official statistics emanating from the Nigerian branch of the United Nations Children’s Fund (UNICEF) is as alarming as it is baffling.

According to Dr. Eather Obinya of UNICEF Office Abuja, the situation is growing worse everyday. Her talks on Accelerated Child Survival and Development (ACSD) and Integrated Maternal, Newborn and Child Health (IMNCH) at the recent Calabar meeting of journalists and UNICEF as well as officials of Child Rights Information Bureau of the Federal Ministry of Information and National Orientation provided much food for thought and bird’s eye view of the threatening health condition.
According to her, the worldwide distribution of such deaths are predominant in Africa. And Nigeria being the most populous country in the continent presents more of these deaths.

For instance, maternal mortality ratio in the country in 1999 and 2003 stood at 704 deaths for every 100,000 live births and 800 deaths for every 100,000 live births respectively. Infant mortality rate was reportedly 90 for every 1,000 births in 2003. The death of children under five years of age rose from 168 for every 1,000 births in 1999 to 201 for every 1,000 live births in 2003.

The grim picture of infant mortality is higher in the troubled oil bearing region of South-South and the three geo-political zones in the north. The reasons for this are largely due to high level of illiteracy of women in these areas and unavailability of basic health facilities and skilled health officials that attend to these women especially during child delivery. In most cases, these women deliver their babies at home at the mercy of the local unskilled birth attendants.

The situation in the South-West and South-East, which recorded low number, was traceable to the fact that more women here attend schools and as such are well informed about caring for their health and that of their unborn children. The case of the South-South is not helped by the upheavals and restiveness in the region occasioned by the festering militancy. The activities of the militants have invariably led to wanton destruction of health facilities which has made it virtually difficult and sometimes impossible for families to seek urgent medical attention.

The hostilities in the region have driven away health workers and sort of put a stop to any health intervention programme either by Nigerians or donor agencies.
The ACSD is a regional strategy to combat child mortality, which is one of the eight aims of Millennium Development Goals (MDGs) while the IMNCH is a national strategy to achieve MDGs of reducing child mortality as well as improving maternal health. The Women and Children Friendly Health Services (WCFHS) are the ways and manner services are offered in ACSD and IMNCH to achieve the MDGs of child and maternal health.

The MDGs are meant to, by 2015, eradicate extreme poverty and hunger and achieve universal primary education. It is also meant to promote gender equality and empower women. Its other goals include reduction of child mortality and improvement of maternal health. The MDGs would combat HIV/AIDs, malaria and other diseases, ensure environmental sustainability and evolve a global partnership for development. But how far has the nation gone in achieving these lofty goals? The prevalence of malaria has reduced from 1, 116, 982 in 1990 to 1,875,389 in 2004.
The HIV prevalence among 15-24 year old pregnant women has reduced from 1.8 percent in 1990 to 5.1 per cent in 2004.

The maternal mortality ratio was 1,000 deaths for every 100,000 births in 1990 and 704 deaths for every 100,000 live births in 2004. In 1990, the proportion of births attended by skilled health workers was 45 percent while in 2004 it was 36 percent whereas the target is 100 percent. The proportion of pregnant women with four or more Antenatal Clinic visits was 52 percent in 1990 and 45 per cent in 2004.

Under-five mortality rate was 191 deaths for every 1,000 live births in 1990 and 201 in 2004 while infant mortality rate was 91 for every 1,000 live births in 1990 and 100 in 2004.
With these grim statistics, it is very unlikely that Nigeria will meet the MDGs goals in reducing child mortality, improving maternal health and combating HIV/AIDs, malaria and other diseases.
Presently, Nigeria is the second largest contributor to maternal mortality rate globally. About 52,900 Nigerian women die annually due to pregnancy related causes.

Over one million children under five years of age will die this year. Daily, 145 women and 2,300 under–five children die, about 30 per cent being new born. Nigeria bears 13.5 per cent of the global burden of HIV in pregnant women yet access to antiretroviral drug is still very low.
Causes of maternal deaths include hemorrhage (23%), Infection (17%), Toxemia/Eclampsia (11%), Unsafe abortion (11%), Obstructed Labour (11%), Malaria (11%), Anemia (11%) and others (5%).

This is the time our various tiers of government should act in concert to stop this carnage on women and children. The resources to achieve this are available. What is needed now is a demonstration of the will to combat the scourge. Let our legislators and other political leaders rise up to this challenge. The MDGs initiatives are laudable and achievable. Let President Umaru Musa Yar’Adua galvanize other leaders in the country to achieve them and reduce the increasing number of child and maternal deaths whose figures have risen to an unacceptable range. Until then, see you after my vacation.

Source:www.sunnewsonline.com

Senior doctor exodus reaches crisis point

Senior doctors are leaving New Zealand to work in Australia at the rate of one a week, according to a survey released exclusively to the Sunday Star-Times.

The union survey, by the Association of Salaried Medical Specialists, says 80 specialists have already gone or have resigned to work across the Tasman in the past 18 months.

That is leading to growing difficulties in caring for patients in certain areas, especially provincial areas which struggle to recruit specialists.

Even urban areas suffer ramifications, with Wellington Hospital last week announcing child cancer patients may have to travel to Auckland or Christchurch after one of its specialists resigned to work in Australia.

Paediatric oncologist Dr Wayne Nicholls left Auckland's Starship Hospital in April to work as a children's brain tumour specialist at Brisbane's Royal Children's Hospital.

Nicholls, 44, said his Australian salary package was 50% more than here, but the move was not just about money.

"In my case it was more money, significantly more money, but it was also better support for professional development."

He also gets significantly more in superannuation and has better opportunities, such as working on a team developing an adolescent cancer unit in Brisbane.

District health boards (DHBs) are embroiled in a pay spat with the union, which is threatening to take industrial action.

The union's survey showed those most likely to go were anaesthetists (13), followed by medical physicians (10), obstetricians and gynaecologists (nine), radiologists (eight), and psychiatrists and paediatricians (seven each).

Auckland and Counties-Manukau were worst hit, with 11 specialists leaving from each. Provinces like Southland, Northland and Bay of Plenty saw an exodus disproportionate to their populations.

College of Obstetricians and Gynaecologists NZ president Dr Alec Ekeroma said the exodus hit rural areas hard. Provincial hospitals, especially in Whangarei, Whakatane and Greymouth, all had vacancies in his specialty. Doctors in smaller hospitals were often on call every second night and lacked the resources of busier urban hospitals.

"It is a concern because it affects standards of care... you can be up all night dealing with a woman who has severe pre-eclampsia and be expected to person gynaecology clinics the next day until 5pm. By midday you're buggered... and thinking `I'm sure there's a better life somewhere else."'

Union executive director Ian Powell said Kiwi specialists were highly sought after in Australia because training and registration systems were similar. Pay rates were higher and conditions better overseas.

An Australian hospital recently offered a union member twice as much as he earns here, plus housing and a car, every fourth week off on top of annual leave, and frequent flights back to New Zealand.

The union is holding stopwork meetings nationwide as it tries to negotiate a new national collective agreement. So far, all have voted to hold a postal vote on whether specialists should take the unprecedented step of industrial action.

DHB spokesman David Meates, chair of the boards' medical workforce strategy group, said doctors had always left New Zealand to work offshore.

"If you look at the past 10 to 15 years, there hasn't been a change in doctors leaving New Zealand."

What has happened is a rise in foreign doctors working here, with a March report showing 41% of doctors registered here gained their early qualifications abroad.

Meates, Wairarapa DHB's chief executive, recently employed obstetricians from South Africa and the US because he could not find locally trained doctors.

Meates said the DHBs had made an offer of final position arbitration with the union. More meetings are scheduled in mid-August.

But that will come too late for Wayne Nicholls, who said it was unlikely he would return here to work because he would need similar opportunities and pay as in Brisbane.

Source:www.stuff.co.nz

Doctor feelgood

I'm six months pregnant and get painful cramping in my legs. Can I do anything about it, or about my swollen ankles?

Answer You have hit on two of the most tedious 'minor' ailments of pregnancy. Both cramps and ankle-swelling are common. The womb gets heavier as the months roll by in the run up to blast-off, and it exerts increasing pressure on your body. There's more fluid in your system at the moment too.

The effect is that the veins in the legs don't get the blood back to the heart just as easily because of the pressure on them. That's also probably the cause of cramp in pregnancy. The best remedy I know is gentle swimming. It seems to help take some of the pressure off your pelvis and will aid your circulation. So will gentle exercise, even walking. Don't sit with your legs crossed, and try sleeping on your side. It's also a good excuse to sit with your feet up, literally. Rubbing your legs and gentle stretching will ease the cramp.

Occasionally leg-swelling can be serious, though. If just one leg is swollen you must see a doctor straight away to rule out the possibility of a blood clot.

In late pregnancy, ankle swelling can be a sign of a condition called pre-eclampsia, a dangerous but treatable complication where blood pressure goes up. Always make sure you get your blood pressure checked when ankles swell in pregnancy, but remember that most of the time the cause is totally harmless.

Source:living.scotsman.com

Dieting can hurt mom and unborn child

Mothers who diet between pregnancies may have an increased risk of premature birth, stillbirth and high blood pressure, Irish researchers said.

The report, published in the British Medical Journal, said women should try to maintain a healthy and consistent weight before, during and after pregnancy, The London Independent said Friday.

Obstetric specialists at Trinity College and Coombe Women's Hospital said dieting can undermine the body's ability to maintain an adequate supply of nutrients to support fetal growth and well-being.

A Swedish study of more than 200,000 women found that increasing BMI -- a measure of body weight relative to height -- by just one or two units significantly increased rates of pre-eclampsia, diabetes and infants born with a high birth weight.

A second study, published last year in the American Journal of Obstetrics and Gynecology, found that women whose BMI fell by five or more units between pregnancies had a higher risk of premature birth, the newspaper said.

Source:www.sciencedaily.com

Yo-yoing mum bad for babes

MUMS who gain or lose lots of weight between pregnancies could be putting their baby at risk, experts warn.

Effects can include premature birth, greater risk of stillbirth and high blood pressure.

Women should instead try to keep a healthy weight before, during and after pregnancy to give their child the best start, two doctors write in the British Medical Journal.
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"An adequate supply of nutrients is essential to support foetal wellbeing and growth," they say.

A study of 207,000 Swedish women found weight gain between pregnancies led to higher rates of pre-eclampsia.

This is linked to high blood pressure in pregnancy; risk of diabetes in the mother; and risk of a baby born overweight.

Source:www.mirror.co.uk

Harvard’s Benjamin Sachs to head Tulane’s med school

A Harvard Medical School professor will become head of Tulane University School of Medicine on Nov. 1, Tulane announced Wednesday.
In addition to teaching at Harvard, Benjamin P. Sachs is chair of obstetrics and gynecology at Beth Israel Deaconess Medical Center.
His success in creating research teams is one reason he was chosen, Tulane President Scott Cowen said.
Sachs created the team that discovered a possible cause of pre-eclampsia _ dangerously high blood pressure that kills hundreds of pregnant women each year _ and could lead to a simple urine test to predict which women are likely to develop it.


Sachs said he was attracted to New Orleans by Tulane’s reputation and the chance to make a difference in the post-Katrina city.
"Tulane has a long history as a leader in medical education, research and patient care and it will be a real privilege to help lead the recovery," Sachs said.
His titles at Tulane, where he also will hold an endowed chair in medicine, will be dean of the medical school and university senior vice president in charge of all medically related activities, including partnerships with other hospitals and universities.
A native of London, Sachs earned his medical degree from the Imperial College there. He has a doctorate in public health from the University of Toronto and was a visiting scientist at the Centers for Disease Control in Atlanta.
Sachs is currently the Harold H. Rosenfield Professor of Obstetrics and Gynecology at Harvard Medical School and a professor in the Department of Society, Human Development and Health at the Harvard School of Public Health.

Source:news.bostonherald.com

Protherics PLC Announces AGM and Interim Management Statement

Protherics PLC ("Protherics" or the "Company"), the international biopharmaceutical company focused on critical care and cancer, provides its Interim Management Statement ahead of the Company's AGM at midday today.

Protherics reported strong financial results for its financial year ended 31 March 2007, with losses for the year reduced from the prior year and a solid financial position. Trading for the first quarter of the current financial year was in-line with expectations. Sales of CroFab(TM) and DigiFab(TM) by our US distributor, Fougera, have been strong and our shipments of product to them over the remainder of the year are anticipated to be ahead of the previous year, also in-line with expectations. We continue to increase our investment in R&D across our expanded pipeline as planned and G&A expenditure will also increase, as previously indicated, reflecting the acquisition of MacroMed in January 2007. We plan these increased expenditures from a strong financial base: unaudited cash balances at 30 June 2007 were USD45m, following the USD10m AstraZeneca milestone payment received in April 2007 and ongoing expenditure is in-line with expectations.

We have also made excellent progress since our preliminary results with our development portfolio:

CytoFab(TM)

Protherics has produced CytoFab(TM) clinical trial material at commercial scale as planned, and AstraZeneca is now preparing to start its additional 480 patient Phase II programme in severe sepsis in the fourth quarter of the 2007.

Digoxin Immune Fab

The Phase IIb DEEP study to investigate the use of Digoxin Immune Fab in severe pre-eclampsia remains on track to report in the first half of 2008. Awareness of the study in the US has increased following recent press coverage.

Voraxaze(TM)

Protherics has commenced the additional manufacturing work requested by the FDA to support a Voraxaze(TM) marketing application in the US. We have also agreed the design of a small study to address the interaction of Voraxaze(TM) with leucovorin, and are preparing the final protocol.

Named patient sales of Voraxaze(TM) in the US have started strongly and are currently ahead of our expectations. This follows FDA approval at the end of May for the supply of Voraxaze(TM) in the US under a Treatment Protocol. Protherics is permitted to charge the commercial price for Voraxaze(TM) to recover some of the costs associated with the programme. Protherics intends to request a meeting with the EMEA in the next few months regarding the potential re-submission of a Marketing Authorisation Application for Voraxaze(TM) in the EU.

OncoGel(TM)

Following the encouraging OncoGel(TM) Phase IIa data in oesophageal cancer reported in June, and following discussions with our Clinical Advisory Board, we have decided to prioritise the development of OncoGel(TM) in combination with pre-operative chemoradiotherapy to improve patient survival. We have met with the EMEA and have a meeting scheduled with the FDA to agree on the protocol for a Phase IIb study, which is planned to start in the US and Europe later in the year.

In March, we initiated a Phase I/II study of OncoGel(TM) in primary brain cancer and we continue recruiting patients into the first dose cohort. We also recently presented encouraging preclinical data for the use of OncoGel(TM) in primary brain cancer at a major scientific conference.

Prolarix(TM)

We recently reported that Cancer Research UK has determined the maximum tolerated dose (MTD) for Prolarix(TM), our prodrug based selective cancer therapy for the treatment of primary liver cancer. Two patients have already been recruited into an additional cohort of 6 patients who will receive up to six cycles of Prolarix at the MTD. Protherics expects Cancer Research UK to report the study in the first half of 2008. Meanwhile, we are planning to start a Phase II study in primary liver cancer in the first half of 2008 to investigate the efficacy of this promising cancer therapy in its lead indication.

Acadesine

We are now close to completing the preclinical testing of acadesine, our selective therapy for the treatment of B-cell Chronic Lymphocytic Leukaemia (B-CLL), which will allow us to commence a proof of concept Phase I/II study in B-CLL patients in the coming months.

Angiotensin Therapeutic Vaccine and CoVaccine HT

We continue preparing for the start of a proof of concept Phase IIa study of our Angiotensin Therapeutic Vaccine, which includes our new proprietary adjuvant, CoVaccine HT, in hypertensive patients in the first half of 2008. We are receiving significant external interest in our adjuvant for use in third party vaccines.

Andrew Heath, Chief Executive of Protherics commented:

"Since the year end, Protherics has made good progress with its portfolio and trading has been strong. We are on track to commence four Phase 2 clinical studies in the current financial year, including AstraZeneca's Phase 2 programme for CytoFab(TM). With these trials commencing and with the Phase 2b pre-eclampsia study reporting, we expect to see significant pipeline progress in the current financial year."

| Ends |
For further information please contact:
Protherics
Andrew Heath, CEO +44 (0) 20 7246 9950
Nick Staples, Director of Corporate Affairs +44 (0) 7919 480510
Saul Komisar, President Protherics Inc +1 615 327 1027
Financial Dynamics - press enquiries
London: Ben Atwell, Anna Keeble +44 (0) 20 7831 3113
New York: John Capodanno, Jonathan Birt +1 212 850 5600

Or visit www.protherics.com

Notes for Editors:

About Protherics

Protherics (LSE: PTI, NASDAQ: PTIL) is a leading biopharmaceutical company focused on the development, manufacture and marketing of specialised products for critical care and cancer.

Protherics has developed and manufactures two biologics for critical care which are FDA approved and currently sold in the US: CroFab(TM), a pit viper antivenom and DigiFab(TM), a digoxin antidote. The Company's strategy is to use the revenues generated from its marketed and out-licensed products to help fund the advancement of its broad, late stage pipeline.

Protherics has two major development opportunities in its critical care portfolio. CytoFab(TM) is being developed by AstraZeneca, for the treatment of severe sepsis, after a major USD195 million ($340 million) licensing deal with AstraZeneca in December 2005. An additional, expanded phase 2 programme is planned to start in the second half of 2007. In addition, Protherics is currently undertaking a phase 2b study with Digoxin Immune Fab for the treatment of pre-eclampsia. This study is expected to report in the first half of 2008.

Protherics has a pipeline of four novel cancer products in clinical development, and intends to undertake the sales and marketing of these products in the US and or the EU. Protherics is preparing to resubmit a BLA for Voraxaze(TM), an adjunct to high dose methotrexate therapy, under a rolling submission in the US starting in early 2008.

Protherics has a strong cash position, with unaudited cash balances at 30 June 2007 of USD45m, having completed a USD38 million equity fundraising in January 2007 and received a USD10 million milestone payment from AstraZeneca in April 2007.

With headquarters in London, the Company has approximately 270 employees across its operations in the UK, US and Australia.

For further information visit: www.protherics.com

Disclaimer

This document contains forward-looking statements that involve risks and uncertainties including with respect to future growth, product development and clinical studies, product sales and regulatory approval of Protherics' products for marketing and distribution. Although we believe that the expectations reflected in such forward-looking statements are reasonable at this time, we can give no assurance that such expectations will prove to be correct. Given these uncertainties, readers are cautioned not to place undue reliance on such forward-looking statements. Actual results could differ materially from those anticipated in these forward-looking statements due to many important factors, including the market for the Company's products, the timing and receipt of regulatory approvals, the progression and results of clinical studies and other factors discussed in Protherics' Annual Report on Form 20-F and other reports filed from time to time with the U.S. Securities and Exchange Commission. We do not undertake to update any oral or written forward-looking statements that may be made by or on behalf of Protherics.

Source:money.cnn.com

Morning sickness linked to lower risk of breast cancer

It may not seem so at the time, but women who suffer through morning sickness during their pregnancies actually may be fortunate.

Those women may have a 30 percent lower risk of developing breast cancer later in life than mothers-to-be who experience nine nausea-free months, a new study by UB epidemiologists.

"Although the exact mechanism responsible for causing nausea and vomiting during pregnancy has yet to be pinpointed, it likely is a result of changing levels of ovarian and placental hormone production, which may include higher circulating levels of a hormone called human chorionic gonadotropin," said David Jaworowicz Jr., first author on the study.

"In vitro studies have shown that this hormone possesses several activities that have potential protective effects against cancer cells," said Jaworowicz, a doctoral candidate in the Department of Social and Preventive Medicine in the School of Public Health and Health Professions.

Jaworowicz's research, which was presented recently at the Society for Epidemiologic Research's annual meeting in Boston, found no association of other pregnancy-related medical conditions—pregnancy-induced hypertension, preeclampsia, gestational diabetes or weight gain—and breast-cancer risk.

The study was based on data from participants in the Western New York Exposure and Breast Cancer Study, a population-based, case-control study of breast cancer conducted in women ages 35-79 from two Western New York counties between 1996 and 2001.

The analysis compared extensive data on pregnancy-related conditions from 1,001 women with primary breast cancer and 1,917 women without breast cancer matched to cases by age and race who served as controls.

"Pregnancy is a time when the breast undergoes a variety of cellular and anatomical changes," said Jaworowicz. "During this period, the breast tissue is exposed to varying levels of a number of hormones, which may affect the physiology of the breast.

"We were interested in the association between pregnancy-related events and characteristics, including pregnancy-induced hypertension, preeclampsia/eclampsia, gestational diabetes, high weight gain during pregnancy, and nausea and vomiting, because these markers may serve as proxies for underlying hormonal changes and altered hormone levels in blood and tissue."

Jaworowicz noted that the presence or absence of these pregnancy-related conditions may indicate a different course or extent of hormone-regulated breast-tissue proliferation and differentiation during pregnancy, but also may indicate distinct hormonal profiles that persist following pregnancy.

Although pregnancy conditions other than nausea and vomiting were not associated statistically with breast cancer risk, these were only preliminary findings, he added, based mainly upon whether women "ever" experienced these conditions vs. "never" during any of their pregnancies.

More nuanced experiences regarding these pregnancy-related characteristics will be the focus of future analyses, he said.

Evidence from the current analysis did suggest that the lower risk of developing breast cancer observed with nausea and vomiting was stronger as the symptoms became more severe, or persisted longer into pregnancy. A modest trend toward increased cancer risk was observed in premenopausal women who gained more than 40 pounds during pregnancy, compared to those who gained less than 23 pounds, said Jaworowicz, but the trend didn't reach statistical significance.

"Pregnancy is a time of drastic physiological changes, including rapid development and alterations in the breast tissue," he noted. "The rapidly changing anatomy of the breast makes it more susceptible to errors in DNA replication and/or repair, which may translate into breast cancer.

"Associated with these changes are the fluctuating hormonal profiles that must be kept in a delicate balance. If the correct ratios and relative amounts between these hormones are not maintained within a normal range, certain pregnancy-related outcomes may emerge, such as high blood pressure, glucose intolerance and gestational diabetes, eclamptic conditions with seizures and/or toxemia, or extremely severe nausea.

"These pregnancy-related factors may serve as indicators of underlying biological conditions that may influence a woman's lifetime risk for breast cancer."

By recognizing that pregnancy-associated medical outcomes may provide easily accessible signals about core changes in the female physiology, future studies should continue to investigate and dissect the intricate relationship that may exist between readily observational perinatal factors, physiological characteristics and cancer risk, Jaworowicz said.

"Subsequent analyses are planned to investigate the potential association between pregnancy characteristics and genetic polymorphisms of particular enzymes responsible for estrogen metabolism. This will help us to elucidate the potential link between pregnancy-associated conditions, hormonal exposures and breast cancer risk."

Additional contributors to the research, from the Department of Social and Preventive Medicine, were Jo Freudenheim, the principal investigator for the study; Jing Nie; Matthew Bonner; Amy Millen; and Dominica Vito.

Alan Hutson, chair of the Department of Biostatistics at UB and Roswell Park Cancer Institute; Christine B. Ambrosone, chair of Roswell Park's Cancer Pathology and Prevention Section; and Paola Muti, now at Italy's National Cancer Institute in Genoa, also contributed to the research.

The study was funded by a grant from the National Institutes of Health.

Source:www.buffalo.edu