Laparoscopic repair of uterine rupture following successful second vaginal birth after caesarean delivery: A case report

BACKGROUND With the increasing trend of vaginal birth after caesarean delivery(VBAC),evaluation of the feasibility and safety of a second VBAC with grand multiparity is worth considering.Intrapartum uterine rupture is diagnosed in approximately one-fifth of all VBAC cases following successful vaginal delivery.To our knowledge,no report is available on the application of laparoscopy to repair postpartum uterine rupture after a successful second VBAC in China.CASE SUMMARY A 31-year-old woman(gravida 5,para 2)at 39 wk and 5 d of gestation was admitted to the hospital in labour.After a successful VBAC and observation for approximately 13 h,the patient complained of progressive abdominal pain.Given the symptoms,signs,and auxiliary examination results,intraperitoneal bleeding was considered.Because the patient was stable and ultrasound imaging was the only method available to assess the possibility of rupture,we recommended laparoscopy to clarify the diagnosis and for prompt laparoscopic uterine repair or exploratory laparotomy if necessary.Operative findings included transverse uterine scar rupture at the lower uterine segment of approximately 5.0 cm in length and 800 mL of intraoperative pelvic haemoperitoneum.Finally,she successfully underwent laparoscopic repair of uterine rupture and recovered very well according to three-dimensional magnetic resonance imaging at 42 d postpartum.CONCLUSION Routine postpartum intrauterine exploration is not beneficial to the mother and may even increase the risk of rupture.This case highlights a laparoscopic approach for repairing uterine rupture in the immediate postpartum period.

Non-Laboring Uterine Rupture of an Unscared Uterus before Term Discover during Obstetric Ultrasound

Uterine rupture is defined as the occurrence of communication between the abdominal and uterine cavity and may be complete or incomplete depending on the degree of involvement of the different layers of the uterus and surrounding organs. It is a rare complication whose consequences often involve the maternal and fetal prognosis. The majority of uterine rupture occurs on the scarred uterus, its incidence in France is estimated according to the series between 1/1000 and 1/2000 births, it represents 30% of causes of maternal death in the developing countries. The authors report here a case of uterine rupture outside of labor at 33 weeks of age in 32 years old woman, gravida 9 para 8, with no history of uterine surgery discovered during obstetric ultrasound for abdominal pain. During the interrogation, she was alarge multipara and had a child of 15 months. The abdominal ultrasound showed a right lateral corporeal rupture with hemoperitoneum of medium sized and a dead fetus. The emergency laparotomy revealed a right lateral uterine wound approximately 15 cm long with intra-abdominal placenta and a haemoperitoneum of medium sized of about 600 cc and a bladder lesion. After opening the amniotic sac, there was extraction of a dead fetus. The uterine and bladder lesions were repaired followed by bilateral tubal ligation. The patient received 500 cc of whole blood during and 500 cc after the procedure. The postoperative follow-up was simple. This case contributes to the knowledge of this rare and atypical event, and emphasizes the importance of maintaining a suspicion.

Wheat breeding in the hometown of Chinese Spring

The common wheat landrace Chinese Spring(CS) was made famous by the work of Ernie Sears, a great cytogenetist, who developed a number of CS-based aneuploid series that were used to identify individual wheat chromosomes. Based on this, a standard karyotype and nomenclature system was developed for wheat chromosomes that allowed wheat researchers to analyze and manipulate the wheat genome with unprecedented precision and efficiency. Nevertheless, not much is known about the utilization of CS at its hometown, Chengdu in Sichuan province, during early wheat breeding activity. In this review, we follow the speculation that CS is a selection from the Cheng-du-guang-tou(CDGT) landrace. We provide a description of how CDGT became a founder landrace for wheat breeding activities in early times. We show that CDGT-derived varieties were reinforced genetically by crosses to six more exotic parents. These varieties remained the major elite cultivar for several decades. Later, synthetic hexaploid wheats were introduced into the breeding program, firstly using those from CIMMYT and later using materials produced with local tetraploid wheat and goat grass. Finally, we discuss the strategies and future directions to improve wheat yield and resistance through an expanded genetic basis,especially by recapturing lost genetic variations from landraces and related wild species, a process that may set an example for wheat breeders in China and elsewhere.

Multiparameter Higher Order Daehee and Bernoulli Numbers and Polynomials

This paper gives a new generalization of higher order Daehee and Bernoulli numbers and polynomials. We define the multiparameter higher order Daehee numbers and polynomials of the first and second kind. Moreover, we derive some new results for these numbers and polynomials. The relations between these numbers and Stirling and Bernoulli numbers are obtained. Furthermore, some interesting special cases of the generalized higher order Daehee and Bernoulli numbers and polynomials are deduced.

Effects of Moringa oleifera and Morinda citrifolia Extracts on Performance of Multiparous Sows and Suckling Piglets

[Objective]The test was to investigate the effects of MM(Moringa oleifera and Morinda citrifolia)extracts on reproductive performance of multiparous sows and growth performance of suckling piglets.[Method]A total of 60 multiparous sows(Landrace×Large White,2-4 parities)were randomly assigned into two treatments,30 replicates per treatment and one sow per replicate.Sows in control group were fed with basal diet,and those in experimental groups were fed with the basal diet supplemented with 500 mg/kg MM extract.The trial lasted 28 d(from 7 d before delivery to 21 d post lactation).[Result]MM extract had no significant effect on sow’s stage of labor and estrus rate at 7 d post weaning(P>0.05).MM extract had no significant impact on growth performance of suckling piglets(P>0.05).[Conclusion]Addition of MM extracts in the diet of multiparous sows at 7 d before delivery did not improve the performance of sows and piglets,but shortened sow’s stage of labor and promoted estrus of sows after weaning to a certain extent.

Autonomic Nervous Activity in Multiparous Women during Early Postpartum Period: A Descriptive Study

Background: The purpose of the present study is to analyze the autonomic nervous activity in multiparas while resting, nursing, and rooming-in/rooming-out during days 1 to 3 of early postpartum period. Methods: Subjects were asked to record the actions they performed while wearing a heart rate monitor. Changes in autonomic nervous activity from 9 am to 12 pm and relaxation based on the relaxation (RE) scale were surveyed in multiparous women experiencing a normal postpartum period, on postpartum days 1 to 3. Results: Thirteen subjects were enrolled but heart rate data for all 3 days were available for only 5 of them. In these patients, the autonomic nervous activity (heat rate, high frequency [HF], or low frequency [LF]/HF) showed no significant differences between the days during any of the time periods. However, of the 3 days, day 2 demonstrated a lower HF and higher LF/HF. Subjective sense of relaxation was higher on postpartum day 3 compared to days 1 and 2, but there was no significant difference observed in the 3-day total score. Though no significant differences in HF and LF/HF at rest and during nursing were observed for any of the 3 days, there was a tendency for HF to be lower and LF/HF to be higher during nursing than at rest. Conclusions: Autonomic nervous activity demonstrated no significant major changes between the 3 days of postpartum (day 1 to 3). However, the lower HF and higher LF/HF during nursing and rooming-in suggest that even multiparas, who are supposedly accustomed to nursing and child-rearing, can be tense. Results suggest that multiparas require monitoring, personal care, and attention so that they can be relaxed and less tense while nursing and caring for their children.

Relation between Obstetric Outcome and Parity

Objectives: To evaluate the prognosis of obstetric complications by parity in a suburban center in Dakar. Patients and Method: We conducted a retrospective and prospective, cross-sectional study that evaluated all women admitted to the Philippe Maguilen Senghor Health Center for the management of their pregnancy (childbirth, abortion, ectopic pregnancy), whether they were primiparous or multiparous. The data for this study covered a 66-month period, from January 1, 2012 to June 30, 2017. Data were entered into our E-perinatal computer database. They were then extracted and analyzed first on Microsoft Excel 2016 and then on SPSS 24, Windows version. Results: Between January 2012 and June 2017, we’ve registered 27,441 patients including 25,905 deliveries, 1415 abortions and 121 ectopic pregnancies. Direct obstetric complications involved 14.1% of our patients. 12.1% multiparous and 17.3% primiparous had at least one direct obstetric complication of World Health Organization (WHO). Antepartum haemorrhage, uterine rupture, ectopic pregnancy, and abortion complications were more common in multipara, whereas prolonged and obstructed labor, preeclampsia, and eclampsia were more common in primiparous women. Postpartum haemorrhage occurred at substantially equal frequencies in both parity groups. We had not found any case of sepsis. Conclusion: Our study confirms that primiparity is a factor that may lead to obstetric complications. However, while some complications were more common in the primiparous, others were exclusive to multiparous when we did not expect it. We also recommend continuing this work by singling out multiparas and large multiparas, in order to better understand the obstetric prognosis linked to parity.

Response of primiparous and multiparous buffaloes to yeast culture supplementation during early and mid-lactation

Strains of live Saccharomyces cerevisiae yeast have exhibited probiotic effects in ruminants. This study investigated the effects of the dietary yeast supplement, S. cerevisiae(Yea-Sacc^(1026)), on primiparous(PP)and multiparous(MP) Egyptian buffaloes in early to mid-lactation. Lactating buffaloes were fed either a basal total mixed ration(TMR, control; 4 PP and 8 MP) or the basal TMR plus 10 g Yea-Sacc^(1026) per buffalo cow per day(yeast; 4 PP and 8 MP). The feeds were given from 15 days prepartum to 180 days postpartum. Feed intake, body weight, and milk yields(MY) were recorded, and milk and blood samples were collected for analyses. Feces were collected from days 45 to 47 during early lactation and from days 90 to92 during mid-lactation to determine apparent digestibility of dry matter(DM), organic matter(OM),crude protein(CP) and crude fiber(CF). Energy corrected milk yield(ECM), feed conversion, and energy and nitrogen conversion efficiency were calculated. Yeast treated MP buffaloes consumed more DM(P < 0.041) and CP than the untreated control group. Apparent digestibility of DM and OM were significantly greater at mid-lactation for treated versus control group(P = 0.001). Crude fiber digestibility was greater in MP than in PP buffaloes(P = 0.049), and yeast supplemented MP cows had a greater CF digestibility than control MP buffaloes at mid-lactation(P = 0.010). Total blood lipids decreased after yeast supplementation(P= 0.029). Milk yields, ECM, fat and protein yields increased for yeast treated MP buffaloes(P < 0.039). The study concluded that the response to yeast supplementation in buffalo cows is parity dependent. Multiparous buffaloes respond to yeast supplementation with an increased DM intake and CF digestibility without significant weight gains, allowing a greater ECM yield with less fat mobilization. Supplementing buffaloes with yeast culture may increase milk production in early lactation and results in a more persistent milk production during mid-lactation. Feed conversion and energy and nitrogen conversion efficiency may be increased with the use of yeast supplementation in Egyptian buffaloes.