Impact of Marriage on Birth Outcomes: Pregnancy Risk Assessment Monitoring System, 2012-2014.

Marriage has been associated with improved pregnancy outcomes. However, as Americans become increasingly accepting of pregnancy and childbearing outside of marriage, many believe the father can support the mother without the parents being married. Some question whether the present normalization of childbearing outside of marriage will negate the protective effect of marriage on pregnancy outcomes. Data from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System were used to obtain data from a sample of 138,118 live singleton deliveries from 2012 to 2014. Odds ratios were compared between married and unmarried mothers for outcomes of preterm delivery, a small for gestational age infant, neonatal intensive care unit admission, vaginal delivery, and breastfeeding initiation. Logistic regression analyses were used to adjust for maternal age, maternal and paternal race, maternal medical comorbidities, maternal smoking status, and receipt of Medicaid. Adjusted odds ratios (AOR) showed married women had a lower risk of preterm delivery (AOR = .877, 95% confidence interval [CI; .811-.948]), a small for gestational age baby (AOR = .838, 95% CI [.726-.967]), and a neonatal intensive care admission (AOR = .808, 95% CI [.754-.866]). Women who were married were more likely to have a vaginal delivery (AOR = 1.144, 95% CI [1.085-1.211]) and to initiate breastfeeding (AOR = 1.601, 95% CI [1.490-1.719]). These data demonstrate that despite a normalization in society of childbearing outside of marriage, there continues to be an association of marriage with improved birth outcomes. Summary: Marriage is associated with a lower risk of preterm delivery, small for gestational age infants, and neonatal intensive care unit admission. These differences persist even after correcting for potentially confounding socioeconomic factors.

When Death Is Not the End: Continuing Somatic Care during Postmortem Pregnancy.

Brain death during the second trimester of pregnancy creates a unique situation in which the mother is deceased, but life of the developing fetus still depends on somatic functions in the mother's body. In this article, I show that when a pregnant woman becomes brain dead during the second trimester, it is morally licit, though not morally obligatory, to continue somatic support while the fetus develops. The interventions on the mother's body are justified for the life of the fetus, especially in light of the unique mother-child dyad and the responsibilities the mother has for her child. However, this therapy is not frequently employed, and its success is unpredictable. In many cases, the expense and uncertain nature of the therapy may make it disproportionate. In such cases, somatic support of the mother's body may be discontinued. SUMMARY: When brain death is diagnosed during pregnancy, it is a challenging decision whether to use artificial ventilation and other heroic measures to support the developing fetus. This paper demonstrates that while these interventions are acceptable, they are not obligatory.

Endoscopic optic nerve decompression for the treatment of traumatic optic nerve neuropathy.

OBJECTIVE: We aimed to investigate the efficacy of endoscopic optic nerve decompression in patients with traumatic optic neuropathy. METHODS: We performed a retrospective analysis of 46 patients with traumatic optic neuropathy in the Shanghai Eye, Ear, Nose and Throat Hospital between March 2002 and September 2005. All patients were first treated with methylprednisolone for 6 days. Forty-four patients (46 eyes) that did not improve with methylprednisolone treatment were offered endoscopic optic nerve decompression. RESULTS: In 38 eyes with no light perception vision preoperatively, 21 eyes (45.6%) had improvement in visual acuity. These patients had postoperative light perception in 17 eyes, hand movement in 3 eyes and 60/200 in 1 eye. Four of 5 eyes with light perception preoperatively had postoperative vision for hand movement in 2 eyes, finger counting in 1 eye and 20/200 in 1 eye. For 3 eyes with preoperative visual acuity of hand movement, the postoperative visual acuities were 60/200, 60/200 and 120/200. Neither worsening of vision nor major complications was encountered in our series. CONCLUSIONS: We conclude that endoscopic optic nerve decompression in experienced surgeons' hands can improve visual acuity in traumatic optic nerve neuropathy with minimal morbidity. Our results also demonstrate that even patients initially without light perception may benefit from optic nerve decompression.

Retrograde neuron tracing with microspheres reveals projection of CGRP-immunolabeled vestibular afferent neurons to the vestibular efferent nucleus in the brainstem of rats.

OBJECTIVE: A new retrograde neuron-tracing technique with microspheres was used to explore the possible innervation of calcitonin gene-related peptide (CGRP)-immunolabeled vestibular afferent neurons in the vestibular efferent immunolabeled nucleus in the brainstem. METHODS: 0.1 microl of 5% microfluorospheres was injected into the area of the vestibular efferent nucleus, which is located lateral to the genu of the facial nerve. CGRP immunohistochemistry was processed in serial sections of the brainstem at the facial nerve genu level. Double-labeled neurons with both CGRP immunoreactivity and microfluorospheres were examined with fluorescence and confocal laser microscopy. RESULTS: Three types of labeled neurons were observed: (1) neurons only retrogradely microfluorosphere-labeled that were mainly located in the medial vestibular nucleus, lateral vestibular nucleus, superior vestibular nucleus and parvicellular reticular nucleus on the ipsilateral side of the injection; (2) neurons that were both immunolabeled with CGRP and also retrogradedly labeled with microfluorospheres, indicating that they are CGRP cells projecting to the area of vestibular efferent nucleus, these cells were mainly distributed in the superior vestibular nucleus and dorsal vestibular nucleus, and (3) cells only immunolabeled for CGRP that were scattered extensively in the brainstem. CONCLUSION: The presented methodical contribution demonstrates the suitability of fluorescein-labeled microspheres for retrograde neuronal tracing. The vestibular nuclei contain numerous afferent neurons that send projections to the vestibular efferent nucleus, some of which are CGRP cells. This afferent innervation provides morphological evidence that the vestibular efferent neurons receive input from the vestibular afferent neurons including CGRP cells. These vestibular primary CGRP afferent neurons may have an influence on vestibular efferent neurons. CGRP acts as an important co-transmitter or modulator in the afferent-mediated activity of vestibular efferent neurons, which in turn affect afferents in the vestibular end organs.