Effects of needs-based education for prenatal anxiety in advanced multiparas: a randomized controlled trial.

BACKGROUND: Prenatal anxiety is a common concern which may have adverse effects on maternal and infant health outcomes. Studies addressing needs-based education interventions for prenatal anxiety are limited. AIM: To explore the effects of needs-based education on alleviating prenatal anxiety among advanced multiparas when compared with routine prenatal health education. METHODS: A total of 86 advanced multiparas were randomized into the intervention group (n = 43) or the control group (n = 43) in this study. The control group received routine prenatal care. The intervention group received five needs-based education programs presented by trained researchers. The Pregnancy-related Anxiety Questionnaire was used to evaluate changes in anxiety level of participants. Concurrent physiological parameters, including blood pressure, heart rate and non-stress test were also measured. RESULTS: Scores on the Pregnancy-related Anxiety Questionnaire of the intervention group were significantly lower than those of the control group (t = 4.21, P < 0.05). Systolic blood pressure (t = 3.64, P < 0.05) and heart rate (t = 2.39, P < 0.05) of the intervention group were also significantly lower than the control group whereas no differences were noted in diastolic blood pressure and non-stress test. CONCLUSION: A needs-based education program is an effective intervention strategy to allay prenatal anxiety in advanced multiparas. TRIAL REGISTRATION: The trial was retrospectively registered in the Chinese Clinical Trial Registry as number ChiCTR2100047552 .

Outpatient vs inpatient Foley catheter induction of labor in multiparas with unripe cervixes: A randomized trial.

INTRODUCTION: Multiparous labor inductions are typically successful, and the process can be rapid, starting from a ripened cervix with a predictable response to amniotomy and oxytocin infusion. Outpatient Foley catheter labor induction in multiparas with unripe cervixes is a feasible option as the mechanical process of ripening is usually without significant uterine contractions and well tolerated. Labor contractions can be initiated by amniotomy and titrated oxytocin infusion in the hospital for well-timed births during working hours as night birth are associated with adverse events. We sought to evaluate outpatient compared with inpatient Foley catheter induction of labor in multiparas for births during working hours and maternal satisfaction. MATERIAL AND METHODS: A randomized trial was conducted in the University of Malaya Medical Center. A total of 163 term multiparas (no dropouts) with unripe cervixes (Bishop score ≤5) scheduled for labor induction were randomized to outpatient or inpatient Foley catheter. Primary outcomes were delivery during "working hours" 08:00-18:00 h and maternal satisfaction on allocated care (assessed by 11-point visual numerical rating score 0-10, with higher score indicating more satisfied). CLINICAL TRIAL REGISTRATION: ISRCTN13534944. RESULTS: Comparing outpatient and inpatient arms, delivery during working hours were 54/82 (65.9%) vs. 48/81 (59.3%) (relative risk 1.1, 95% CI 0.9-1.4, p = 0.421) and median maternal satisfaction visual numerical rating score was 9 (interquartile range 9-9) vs. 9 (interquartile range 8-9, p = 0.134), repectively. Duration of hospital stay and membrane rupture to delivery interval were significantly shorter in the outpatient arm: 35.8 ± 20.2 vs. 45.2 ± 16.2 h (p = 0.001) and 4.1 ± 2.9 vs. 5.3 ± 3.6 h (p = 0.020), respectively. Other maternal and neonatal secondary outcomes were not significantly different. CONCLUSIONS: The trial failed to demonstrate the anticipated increase in births during working hours with outpatient compared with inpatient induction of labor with Foley catheter in parous women with an unripe cervix. Hospital stay and membrane rupture to delivery interval were significantly shortened in the outpatient group. The rate of maternal satisfaction was high in both groups and no significant differences were found.

Induction of labour from 39 weeks in low-risk multiparas with ripe cervixes: A randomised controlled trial.

BACKGROUND: Induction of labour (IOL) in low-risk nulliparas at 39 weeks reduces caesarean delivery. Multiparas with ripe cervixes typically have vaginal delivery within eight hours. Delivery at night and weekend are associated with higher maternal and neonatal mortality. AIMS: To evaluate IOL in full-term multiparas with ripe cervixes to achieve delivery at normal working hours and improve maternal satisfaction. METHODS: A randomised trial was performed in a tertiary hospital in Malaysia. Low-risk multiparas with ripe cervixes (Bishop score ≥6) were recruited at 38+4 -40+0  weeks, then randomised to planned labour induction at 39+0  weeks or expectant care. Primary outcomes were delivery during 'normal working hours' 09:00-17:00 hours, Monday-Friday and patient satisfaction by visual numerical rating scale. RESULTS: For IOL (n = 80) vs expectant care (n = 80) arms respectively, primary outcomes of delivery at normal working hours was 27/80 (34%) vs 29/78 (37%), relative risk (RR) 0.9, 95% CI 0.5-1.7, P = 0.41, patient satisfaction was 8.0 ± 1.8 vs 7.8 ± 1.6, P = 0.41; presentation for spontaneous labour or rupture of membranes were 27/80 (34%) vs 70/79 (89%), RR 0.4, 95% CI 0.3-0.5, P < 0.001; and for labour induction 52/80 (65%) vs 15/79 (19%), RR 3.4, 95% CI 2.1-5.5, P < 0.001. Caesarean delivery was 8/80 (10%) vs 4/79 (5%), RR 2.0, 95% CI 0.62-6.3, P = 0.25; and mean birthweight was 3.1 ± 0.3 vs 3.3 ± 0.4 kg, P = 0.06 for IOL vs expectant care, respectively. CONCLUSION: Labour induction in low-risk multiparas does not increase births during working hours or improve patient satisfaction. Antenatal clinic visits and non-birth hospitalisation were significantly reduced.

Cervical dilation at the time of epidural catheter insertion is not associated with the degree of prolongation of the first or second stages of labor, or the rate of instrumental vaginal delivery.

INTRODUCTION: Epidural analgesia (EA) is an established option for efficient intrapartum analgesia. Meta-analyses have shown that EA differentially affects the first stage of labor but prolongs the second. The question of EA timing remains open. We aimed to investigate whether EA prolongs delivery in total and whether the EA administration timing vis-à-vis cervical dilation at catheter insertion is associated with a modulation of its effects on the duration of the first and second stages, as well as the rate of instrumental vaginal delivery in primiparas and multiparas. MATERIAL AND METHODS: A retrospective electronic medical records-based study of 18 870 singleton term deliveries occurring in our institution from 2003 to 2015. Cervical dilation was determined within a half-hour of EA administration. We examined whether cervical dilation at EA administration correlated with the duration of the first and/or second stage, with the rate of prolonged second stage, and with the rate of interventional delivery. The study group was stratified to 10 subgroups defined by 1-cm intervals of cervical dilation at EA administration. Logistic regression modeling was applied to analyze the association between EA timing and rate of instrumental delivery while controlling for possible confounders. RESULTS: In primiparas, receiving EA correlated with longer medians of active first stage (+51 minutes; P < .001) and second stage (+55 minutes; P < .001). In multiparas, median increases in active first stage (+43 minutes; P < .001) and second stage (+8 minutes; P < .001) were noted. The timing of EA, vis-à-vis cervical dilation (1-10 cm) was not associated with a substantial modulation of these effects. Logistic regression showed that cervical dilation at EA was not associated with a higher instrumental vaginal delivery rate. CONCLUSIONS: Epidural analgesia prolonged the first and second stages of labor vs no epidural. Having EA was associated with a higher instrumental delivery rate but not with higher rates of maternal or neonatal complications, in primi- and multiparas. Importantly, the timing of EA, vis-à-vis cervical dilation, was not associated with substantial changes in the duration of labor stages or the instrumental delivery rate. Thus, EA may be offered early in the first stage of labor.

Unplanned Cesarean Delivery in the Second Stage of Labor Holds Higher Odds of Complications than in the First Stage, while Similar in Primiparas and Multiparas.

BACKGROUND: While endeavors to reduce cesarean delivery (CD) rates are given priority worldwide, it is important to evaluate if these efforts place parturients and neonates at risk. CD performed in the second stage of labor carries higher risks of maternal and fetal complications and is a more challenging surgical procedure than that performed in the first stage or before labor. In a population with a low CD rate, we sought to evaluate the rate of maternal and fetal complications associated with unplanned CD (UCD) performed in the second vs. the first stage of labor, in primiparas and multiparas, as well as the risk factors leading to and the complications associated with UCD in the second stage of labor in this low-CD rate setting. METHODS: This was a retrospective, electronic medical record-based study of 7,635 term and preterm singletons born via UCD in the period 2003-2015. Maternal and neonatal background and outcome parameters were compared between groups. Logistic regression modeling was applied to adjust for clinically and statistically significant risk factors. RESULTS: UCD was more likely to be performed in the second stage of labor in mothers delivering larger fetuses (head circumference and body weight ≥90 centile) and those with persistent occiput posterior (POP) presentation. UCD in the second stage was strongly associated with serious maternal complications (excessive hemorrhage and fever) compared to UCD performed in the first stage, in both primiparas and multiparas. CONCLUSIONS: UCD performed in the second stage of labor, while less frequent than first-stage UCD, is more likely with larger neonates and POP presentation, and is associated with a higher rate of maternal complications in primiparas and multiparas. Complication rates in our low-CD-rate population did not exceed those reported in the literature from high-CD-rate areas.

Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study.

BACKGROUND: The differences in post-operative pain are unclear between the primiparas who underwent a primary cesarean section and multiparas who underwent their first repeat cesarean section. The study aimed to explore the possible differences in postoperative pain between primiparas and multiparas. METHODS: A prospective cohort study was performed only including women who underwent cesarean deliveries under spinal anesthesia. Postoperative patient-controlled intravenous analgesia (PCIA) was administered to all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen; the pump was programmed as 2.0 mL/h background infusion with a loading dose of 1 mL and a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using the visual analogue scale, and inadequate analgesia was defined as a visual analogue scale score ≥ 40 during 48 h post-operation. Additionally, the patients' pain statuses in postoperative week 1 and week 4 were also assessed during follow-up via telephone. RESULTS: From January to May 2017, a total of 168 patients (67 primiparas and 101 multiparas) were included. The relative risk for multiparas to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primiparas. In patients aged < 30 years, inadequate analgesia on visceral pain was higher in multiparas than in primiparas (RR, 3.56 [1.05 to 12.04], P = 0.025). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multiparas and primiparas (33.7% vs. 40.2%, P = 0.381). No difference was found in PCIA use between the two groups (111.1 ± 36.0 mL vs. 110.9 ± 37.3 mL, P = 0.979). In addition, a significantly higher incidence of pain was noted 4 weeks post-surgery in primiparas than that in multiparas (62.2% vs. 37.7%, P = 0.011). CONCLUSION: Multiparas who underwent their first repeat cesarean section have a lower for inadequate analgesia on incision pain during the first 48 h after surgery than primiparas. Multiparas aged under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain. TRAIL REGISTRATION: ClinicalTrial.gov: NCT03009955 , Date registered: December 30, 2016.

Influence of Experiences and Perceptions Related to Breastfeeding One's First Child on Breastfeeding Initiation of Second Child.

Introduction Multiparas tend to initiate breastfeeding less than primiparas. While mothers often repeat the feeding method used for their first child with their second child, the way in which experiences and maternal perceptions related to breastfeeding one's first child may influence breastfeeding initiation with a second child remain underexplored. The objective of this study was to investigate whether physiological or social experiences, and related psychological factors, reported at the end of breastfeeding one's first child influence breastfeeding initiation with a second child. Methods Data from 174 multiparas who participated in the Infant Feeding Practices Study II, breastfed their first child, and completed the Year 6 Follow Up were analyzed using exact logistic regression. Results Mothers who reported experiencing trouble with the first baby's suck or latch had lower odds of initiating breastfeeding (OR 0.15, 95% CI 0.04-0.56) than those who did not report this experience, whereas mothers who agreed that breastfed children are less likely to become obese had greater odds of initiating breastfeeding with a second child (OR 11.49, 95% CI 1.56-513.18) than those who did not agree. Discussion Efforts to facilitate breastfeeding initiation among multiparas may consider mothers' previous experiences and beliefs associated with breastfeeding. Strategies to facilitate initiation may focus on addressing barriers mothers experienced while breastfeeding their first child and increasing awareness about how breastfeeding may prevent childhood obesity. Future research should explore how such approaches may impact breastfeeding outcomes with subsequent children.

Routine vaginal examination to assess labor progress at 8 compared to 4 hours after early amniotomy following Foley balloon ripening in the labor induction of multiparas: a randomized trial.

BACKGROUND: Vaginal examination to monitor labor progress is recommended at least every 4 hours, but it can cause pain and embarrassment to women. Trial data are limited on the best intensity for vaginal examination. Vaginal examination is not needed for oxytocin dose titration after an amniotomy has been performed and oxytocin infusion started. The Foley balloon commonly ripens the cervix without strong contractions. Amniotomy and oxytocin infusion are usually required to drive labor. OBJECTIVE: This study aimed to evaluate the first vaginal examination at 8 vs 4 hours after amniotomy-oxytocin after Foley ripening in multiparous labor induction. STUDY DESIGN: A randomized controlled trial was conducted from October 2021 to September 2022 at the University Malaya Medical Center, Kuala Lumpur, Malaysia. Multiparas at term were recruited at admission for labor induction. Participants were randomized to a first routine vaginal examination at 8 or 4 hours after Foley balloon ripening and amniotomy. Titrated oxytocin infusion was routinely commenced after amniotomy to initiate contractions. The 2 primary outcomes were the time from amniotomy to delivery (noninferiority hypothesis) and maternal satisfaction (superiority hypothesis). Data were analyzed using the Student t test, Mann-Whitney U test, and chi-square test (or Fisher exact test), as suitable for the data. RESULTS: A total of 204 women were randomized, 102 to each arm. Amniotomy to birth intervals were 4.97±2.47 hours in the 8-hour arm and 5.79±3.17 hours in the 4-hour arm (mean difference, -0.82; 97.5% confidence interval, -1.72 to 0.08; P=.041; Bonferroni correction), which were noninferior within the prespecified 2-hour upper margin, and the maternal satisfaction scores (11-point 0-10 numerical rating scale) with allocated labor care were 9 (interquartile range, 8-9) in the 8-hour arm and 8 (interquartile range, 7-9) in the 4-hour arm (P=.814). In addition, oxytocin infusion to birth interval difference was noninferior within the 97.5% confidence interval (-1.59 to 0.23) margin of 1.3 hours. Of the maternal outcomes, the amniotomy to first vaginal examination intervals were 3.9±1.8 hours in the 8-hour arm and 3.4±1.3 hours in the 4-hour arm (P=.026), and the numbers of vaginal examinations were 2.00 (interquartile range, 2.00-3.00) in the 8-hour arm and 3.00 (interquratile range, 2.00-3.25) in the 4-hour arm (P<.001). For the 8-hour arm, the first vaginal examination was less likely to be as scheduled and more likely to be indicated by sensation to bear down (P<.001), and the epidural analgesia rates were lower (13/102 participants [12.7%] in the 8-hour arm vs 28/102 participants [27.5%] in the 4-hour arm; relative risk, 0.46; 95% confidence interval, 0.26-0.84; P=.009). Other outcomes of the mode of delivery, indications for cesarean delivery, and delivery blood loss were not different. Neonatal outcomes were not different. CONCLUSION: Routine first vaginal examination at 8 hours compared with that at 4 hours was noninferior for the time to birth but did not improve maternal satisfaction.

Safety and Efficacy of Cervical Ripening and Induction of Labor Using Prostaglandin E1 in Primiparas, Multiparas and Grand Multiparas.

Objective: To compare the efficacy and safety of cervical ripening and induction of labor with prostaglandin E1 among primiparas, multiparas and grand multiparas. Study design: This was a retrospective cohort study. Results: Between January and December 2017, 1713 women underwent cervical ripening and induction of labor with prostaglandin E1: 523 were primiparas, 656 were multiparas, and 534 were grand multiparas. Four hundred and seventy-nine (91.6%) primiparas delivered vaginally as did 640 (97.6%) multiparas and 521 (97.6%) grand multiparas. Forty-four (8.4%) primiparas underwent cesarean delivery compared to 16 (2.4%) multiparas and 13(2.4%) grand multiparas. Induction to delivery interval was significantly longer in primiparas (29.7 ± 22.8 h). There were no cases of uterine rupture, and the rates of postpartum hemorrhage and endometritis were similar among the three groups. Neonatal outcomes including Apgar score < 7 and umbilical artery pH < 7.1 were not significantly different between the groups. Conclusion: Using prostaglandin E1 for cervical ripening and labor induction is efficient and safe in primiparas, multiparas and grand multiparas.

Digital vs speculum-guided catheter balloon insertion for cervical ripening in multiparas: a randomized controlled trial.

BACKGROUND: Catheter balloon insertion into the maternal uterine cervix is routinely speculum guided; digital insertion has been reported, but it was not found to be more tolerable among nulliparas. OBJECTIVE: In a cohort of multiparas, we aimed to evaluate maternal pain, the induction to delivery interval, and maternal satisfaction with digital insertion vs speculum-guided placement of a Foley catheter balloon for labor induction. STUDY DESIGN: This randomized trial was conducted at a single, tertiary, university-affiliated hospital. The participants were multiparas (parity ≥1) and were admitted at term for labor induction with a Bishop score <6. They were randomized to 2 groups, namely the digital insertion and the speculum-guided Foley catheter insertion groups. An intention-to-treat analysis was performed. The co-primary outcomes were visual analog scale scores (0-10) and induction to delivery intervals. Secondary outcomes were procedure duration, maternal satisfaction, cervical ripening (Bishop score ≥6), delivery within 24 hours, infection rate, and neonatal outcomes. RESULTS: A total of 50 women were analyzed for each study group. For the digitally inserted vs speculum-guided insertion group, the median visual analog scale score at catheter insertion was lower (4; range, 0-10; vs 7; range, 0-10; P<.001), and the induction to delivery interval was similar. For the digitally inserted vs speculum-guided insertion group, the median maternal satisfaction score was greater (5; range 3-5; vs 4; 1-5; P=.01), and the median procedure duration was shorter (2.1; range, 1.4-5.3 minutes vs 3.0; range, 1.4-5.0; P<.001). In the multivariate analysis, digital insertion (P=.009) and increased parity (P=.001) independently decreased the visual analog scale score. Cervical ripening, the maternal infection rate, and the neonatal outcomes did not differ significantly between the groups. CONCLUSION: Digital insertion of a Foley catheter balloon for cervical ripening in multiparas is less painful and quicker than speculum-guided insertion. It is also not inferior in terms of successful cervical ripening.

Deficient maternal behavior in multiparous Pou3f2⊿ mice is associated with an impaired exploratory activity.

Mammalian adult females develop specialized body parts, namely mammary glands and uterus, and exhibit specialized maternal behavior, lactation/nursing and care for their offspring. As the brain plays an essential role in regulating related physiological functions in the body, the morphology or function of the mammalian brain has been modified to manage newly equipped structures and functions. However, this evolutionary process is largely unknown. Pou3f2/Brn2 is an evolutionarily remarkable gene as it contains mammal-specific base sequences encoding three stretches of homopolymeric amino acids (polyAAs): poly-glycine (polyG), poly-glutamine (polyQ), and poly-proline (polyP). Previously, we demonstrated that POU3F2 acquisition of mammal-specific polyAAs contributed to the establishment of behaviors characteristic of mammals. Here, we demonstrated that Pou3f2⊿ mice displayed basic features required for maternal care. However, Pou3f2⊿ mice exhibited deficits in the reproductive performance and maternal behavior, which were not fully improved by multiparas. Therefore, we extensively investigated pup retrieval behavior and discovered that the retrieval and the exploratory behaviors were impaired in Pou3f2⊿ female mice, but not in males. Altogether, our data suggest that POU3F2 acquisition of mammal-specific polyAAs contributes to the continuous awareness and curiosity needed for maternal interaction.

Development of a scale for parent-to-baby emotions: Concepts, design, and factor structure.

Aim: Although infant crying is a prerequisite for a baby's survival, it often leads to negative consequences for the caregivers. We hypothesized that this would be mediated by a primary emotion that we feel directly in response to an internal or external event. Hence, this study aimed to develop a new scale to measure basic and self-conscious emotions as primary emotions towards an infant's cry. Methods: We conducted a cross-sectional web survey including the scale for parent-to-baby emotions (SPBE)-with 73 items elicited from a literature review-targeted at mothers at 1 month after childbirth (N = 879). A series of explanatory and confirmatory factor analyses were conducted using item parcels. Internal consistency of the scale was calculated by omega indices. We also examined measurement invariance of the scale. Results: The theory-driven six basic emotions bifactor model (comparative fit index [CFI] = 0.968, root mean square of error approximation [RMSEA] = 0.070) and four self-conscious emotions factor model (CFI = 0.973, RMSEA = 0.079) were judged as the best models. They were stable in terms of configural, measurement, and structural invariances across parity. Conclusion: The SPBE we created is a psychometrically robust measure to assess the primary emotions under the rubric of parent-to-baby emotions. It is a promising tool for measuring parent-to-baby emotions in clinical and research settings.

Impact of vaccination on the reproductive performance of multiparous Nellore cows / Impacto da vacinação sobre o desempenho reprodutivo de vacas Nelore multíparas

Two experiments were conducted to evaluate the impact of two vaccines on the reproductive performance of multiparous beef cows in Mato Grosso do Sul, Midwest Brazil. In Experiment 1,765 calved multiparous Nellore cows were subjected to the same fixed-time artificial insemination (FTAI) protocol and rebred. Ultrasound pregnancy diagnosis was performed 30 and 90 days post-FTAI (DPI). Rates of pregnancy and pregnancy loss were determined for three periods: from 30 to 90 DPI, from 30 DPI to calving, and from 90 DPI to calving. The cows were assigned to three groups with different vaccination protocols - namely, Group VACMULT (n=250): vaccine against bovine herpesvirus 1 (BoHV-1), bovine viral diarrhea virus (BVDV), and leptospirosis; Group VACL (n=245): vaccine against leptospirosis alone; Group NOVAC (n=270): no vaccination. Serum antibody titers for BoHV-1, BVDV, and leptospirosis, measured in 57 cows from each group indicated active infection, suggesting circulation of these pathogens in the herd. No differences in pregnancy rates were observed across groups. Pregnancy loss rates did not differ significantly across groups within any of the periods investigated (30 to 90 DPI, 30 DPI to calving, or 90 DPI to calving). In Experiment 2, two vaccination protocols for each vaccine were investigated. Group VACGEST was vaccinated on day zero of FTAI (D0) and again 30 days post-FTAI (30 DPI). Group VACPREV was vaccinated on D0 and again on the day of insemination (D11). No significant difference was observed between groups, or significant gestational loss in the group that received the second vaccine on the day of insemination. The results revealed that neither vaccine interfered with the reproductive performance of multiparous cows. No differences were observed between vaccination carried out on both D0 and D11 and that performed on both D0 and D30. The performance of the IBR/BVDV/Leptospirosis vaccine on the day of the artificial insemination did not cause adverse effects on the reproductive parameters.(AU)

Foram delineados dois experimentos para avaliar o impacto de duas vacinas no desempenho reprodutivo de vacas multíparas de bovinos de corte em Mato Grosso do Sul, Centro-Oeste do Brasil. No Experimento 1 foram utilizadas 765 vacas multíparas paridas da raça Nelore submetidas ao mesmo protocolo de inseminação artificial em tempo fixo (IATF) e repassadas por touros. O diagnóstico de gestação por ultrassonografia foi realizado aos 30 e 90 dias pós IATF. A prenhez e a taxa de perda de gestação foram determinadas para três períodos: de 30 a 90 DPI, de 30 DPI até para o parto e de 90 DPI até o parto. As vacas foram distribuídas em três grupos: grupo VACMULT (n=250), vacinado com vacina contra herpesvírus bovino tipo 1 (BoHV-1), vírus da diarreia viral bovina (BVDV) e leptospirose; grupo VACL (n=245), vacinado somente contra leptospirose; e grupo NOVAC (n=270), não vacinado. Títulos de anticorpos no soro de 57 vacas de cada grupo evidenciaram infecção por BoHV-1, BVDV e leptospirose, sugerindo circulação desses patógenos no rebanho. No diagnóstico por ultrassonografia, a prenhez não diferiu em nenhum dos três grupos. A taxa de perda de gestação não diferiu significantemente entre os grupos e dentro de qualquer um dos períodos investigados (30 a 90 DPI, 30 DPI até o parto ou 90 DPI até o parto). No Experimento 2 foram testados dois protocolos de vacinação usando as vacinas contra IBR/BVDV/leptospirose e somente contra leptospirose em ambos. No grupo VACGEST as vacas foram vacinas no dia zero (D0) do protocolo da IATF e 30 dias pós- IATF (30 DPI). No grupo VACPREV a primeira dose foi administrada no D0 e a segunda no mesmo dia da IATF (D11). Não houve diferença significativa entre os grupos, nem perda gestacional significativa no grupo que recebeu a segunda vacina no dia da inseminação (VACPREV). Os resultados mostram que as vacinas contra IBR/BVDV/leptospirose e somente contra leptospirose não interferiram no desempenho reprodutivo de vacas multíparas. Não houve diferença significativa entre o protocolo de vacinação empregado em D0 e D11 e aquele utilizado em D0 e 30 DPI. A realização da vacina contra IBR/BVD/leptospirose no dia da inseminação artificial não provocou efeitos adversos nos parâmetros reprodutivos.(AU)

Gemelos unidos (siameses): descripción de hallazgos anatomopatológicos / Conjoined twins (siamese): description of anatomopathological findings

Resumen OBJETIVO: Describir los hallazgos anatomopatológicos y placentarios en una serie de autopsias de 5 siameses. CASOS CLÍNICOS: Serie de casos de autopsias efectuadas entre 2013 y 2018 de pacientes entre 14 y 30 semanas de embarazo, con diagnóstico de gemelos unidos. RESULTADOS: Se encontraron 5 casos de gemelos unidos, hijos de madres multíparas, 3 tuvieron muerte intrauterina y 2 fallecimiento a los pocos minutos de vida. Tres casos correspondieron a uniones ventrales (2 toracoonfalópagos y 1 cefalópago) y dos a uniones laterales de tipo parápagos, dicéfalos. Hubo corazón único en los gemelos toracoonfalópagos y sistemas cardiacos separados en los tres restantes, donde hubo fusión aórtica distal. En 4 casos el hígado se encontró fusionado, con dos vías biliares independientes. Los cordones umbilicales de los casos de unión ventral tenían 5 vasos sanguíneos. Los de unión lateral tenían cordón umbilical trivascular. Los discos placentarios mostraron grados variables de hipoxia preplacentaria y cambios de malperfusión vascular materna. CONCLUSIONES: Las fusiones ventrales tienen grados variables de estructuras compartidas; entre mayor sea la fusión de los órganos internos, menor es el número de vasos umbilicales. De las teorías etiológicas propuestas, la esférica es la que mejor soporta los grados variables de fusión.

Abstract OBJECTIVE: Description of the anatomopathological and placental findings in a series of autopsies of 5 conjoined twins. MATERIALS AND METHODS: Series of cases of autopsies performed between 2013-2018 of patients between 14-30 weeks of gestation, with diagnosis of conjoined twins. RESULTS: Five cases of conjoined twins, product of multiparous mothers, 3 of these presented intrauterine death and 2 deaths within a few minutes of life. Three cases corresponded to ventral junctions (2 thoracoomphalopagus and 1 cephalopagus) and two to lateral junctions of parapagus type. A single heart was observed in the thoracoomphalopagus twins and separated cardiac systems in the remaining three where there was distal aortic fusion. In 4 cases the liver was found fused with two independent bile ducts. The umbilical cords of the cases of ventral union presented 5 blood vessels; those with lateral junction presented a trivascular umbilical cord. The placentas showed varying degrees of preuterine hypoxic pattern and changes of Maternal Vascular malperfusion of the Placental Bed. CONCLUSIONS: Ventral fusions have varying degrees of shared structures; the greater the fusion of the internal organs, the smaller the number of umbilical vessels will be. Of the proposed etiological theories, it is the so-called spherical theory, which best supports the variable degrees of fusion and how it can be saltatory on the vertical axis.

Productive performance of sows fed increasing levels of distillers dried grains with solubles (DDGS) across parities / Comportamiento productivo de cerdas alimentadas con niveles crecientes de granos secos de destilería con solubles (DDGS) durante varios partos / Desempenho produtivo de porcas alimentadas com níveis crescentes de grãos secos de destilaria com solúveis (DDGS) durante vários partos

Background: of distillers dried grains with solubles (DDGS) in lactation diets may contribute to productive performance of lactating sows of different parities. Objective: the objective of this study was to determine the effects of feeding diets containing different levels of DDGS on productive performance of lactating sows of different parities. Methods: a total of 245 sows were divided into 3 parity groups of 1 to 2, 3 to 5, and over 5 parities. Within each parity group, sows were allotted to 1 of 4 dietary treatments that were prepared by inclusion of 0, 10, 20, and 30% DDGS in lactation diets. Diets were fed to sows during the whole lactation period. Results: average piglet weaning weight tended (quadratic, p<0.10) to increase by feeding diets containing increasing levels of DDGS to lactating sows of 3 to 5 and over 5 parities. Likewise, increasing levels of DDGS in diets tended (quadratic, p<0.10) to increase average piglet weight gain in all sow parity groups. The improvement of average piglet weaning weight and average piglet weight gain was the greatest when sows of 3 to 5 parities were fed diets containing 20% DDGS or when sows of over 5 parities were fed diets containing 10% DDGS compared with other dietary treatments. Feeding diets containing different levels of DDGS had no negative effects on other productive performance of lactating sows, regardless of parity. Conclusions: DDGS can be included up to 30% in diets fed to lactating sows of different parities.

Antecedentes: la inclusión de granos secos de destilería con solubles (DDGS) en las dietas de lactancia puede contribuir al desempeño productivo entre cerdas lactantes de diferentes partos. Objetivo: determinar los efectos de varios niveles dietarios de DDGS en el comportamiento productivo de cerdas lactantes de diferentes partos. Métodos: un total de 245 cerdas fueron divididas en 3 grupos según el número de partos: de 1 a 2, 3 a 5, y más de 5 partos. Dentro de cada grupo de partos, las cerdas se asignaron a 1 de 4 tratamientos dietarios que incluían 0, 10, 20, o 30 % de DDGS en la dieta de lactancia. Las dietas fueron administradas a las cerdas durante todo el período de lactancia. Resultados: el peso al destete de los lechones tendió (cuadrática, p<0,10) a aumentar con el consumo creciente de DDGS por cerdas lactantes de 3 a 5 o de más de 5 partos. Del mismo modo, los niveles crecientes de DDGS tendieron (cuadrática, p<0,10) a aumentar la ganancia media de peso de los lechones en todos los partos. La mejora del peso promedio al destete y ganancia de peso de los lechones fue mayor para las cerdas de 3 a 5 partos que consumieron 20 % de DDGS, o para cerdas de más de 5 partos consumiendo 10 % de DDGS. Las dietas con diferentes niveles de DDGS no tuvieron efectos negativos sobre otros parámetros productivos de las cerdas lactantes, independientemente de la paridad. Conclusiones: los DDGS se pueden incluir hasta un 30% en las dietas de cerdas lactantes de diferente orden de parto.

Antecedentes: a inclusão de grãos secos de destilaria com solúveis (DDGS) em dietas de amamentação pode contribuir para o desempenho produtivo de porcas lactantes com diferentes partos. Objetivo: determinar os efeitos de diferentes níveis dietéticos de DDGS no desempenho produtivo de porcas em lactação com diferente número de partos. Métodos: um total de 245 fêmeas foram divididas em três grupos segundo seu número de partos: 1-2, 3-5, e mais de 5 partos. Dentro de cada grupo de parição, as porcas foram designadas para um de quatro tratamentos de diferentes dietas que forneciam 0, 10, 20, ou 30% de DDGS na dieta de amamentação. As dietas foram fornecidas às porcas durante o período de lactação. Resultados: o peso ao desmame dos leitões tendeu (quadrática, p<0,10) a incrementar com o aumento do consumo de DDGS das porcas lactantes dos grupos 3-5 e mais de 5 partos. Do mesmo jeito, os níveis crescentes de DDGS (quadrática, p<0,10) aumentaram o ganho de peso médio dos leitões das porcas dos três grupos avaliados. A melhora do peso médio a desmama e o ganho de peso médio dos leitões foi maior nas porcas de 3-5 partos que consumiram 20% de DDGS e nas porcas de mais de 5 partos que consumiram 10% de DDGS. As dietas com diferentes níveis de DDGS não tiveram efeitos negativos sobre os outros parâmetros produtivos das porcas em lactação, independentemente do número de partos. Conclusões: os DDGS se podem incluir nas dietas das porcas com diferentes números de partos até num 30%.