After Birth Ebook

Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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Pregnancy Without Pounds

This proven program will get you through your pregnancy in better shape than most other women in as little as 27 minutes a day and with minimal effort. It contains all the information that I believe will Help you to look and feel like I did barefoot and beautiful! Inside you will learn Exactly how to avoid unwanted pounds, overcome your food cravings, care for your skin, dress to kill and look like one Hot Mama. Ive also put together Fifty simple, yet extremely effective pregnancy-friendly exercises and stretches to keep you and your body looking and feeling Great (includes 3 different fitness programs depending on Your fitness level)!

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CD4CD25 Regulatory T Cells

Immune tolerance has been a topic of intensive research since the early 1950s. The Nobel Prize winning work of Peter Medawar and colleagues showed that intraembryonic injection of foreign tissue cells into CBA mice resulted in tolerance when skin grafts from the same donor were transplanted into the mice after birth 1 . This immune tolerance was not due to antigenic alteration of the grafts, since injection of lymph node suspensions derived from CBA mice pre-immunized with donor cells led to breakdown of tolerance. Rather it was suggested that active immune tolerance was present. The concept that active tolerance could be mediated by suppressor T cells was introduced in the early 1970s by Gershon and co-workers 2-4 . They showed that the presence of thymocytes during antigen exposure of thymectomized, lethally irradiated and bone marrow-grafted mice resulted in tolerance upon subsequent exposure to the same antigen, even after the addition of fresh thymocytes during the rechallenge....

Ethics Of Dna Testing For Inherited Disease

In the future it may be possible to correct genetic defects before or after birth by replacing mutated genes by a normal copy. The technology to carry out such experiments is very demanding and important ethical questions are raised. In Chapter 20 we will discuss the potential use of gene therapy for the correction of the genetic disorder cystic fibrosis.

Type Natriuretic Peptide

Ventricular synthesis of ANP is high in late fetal and early neonatal life but is rapidly reduced within the first few weeks after birth (30,31). Volume or pressure overload of the cardiac ventricles, leading to ventricular hypertrophy, is associated with ventricular reexpression ofthe gene for ANP (32). In fact, expression ofthe genes encoding ANP and BNP is considered a reliable marker ofthe hypertrophic program in experimental models associated with ventricular hypertrophy. The predominant stimulus for ANP release appears to be myocyte stretch, rather than transmural pressure load (33) (Table 2). In vivo, plasma ANP levels increase rapidly in response to pressure as well as volume loading (34-36),

Clinical Correlation

When discussing hepatic hyperbilirubinemia earlier in this chapter, it was noted that neonatal jaundice is typically due to the short-term or transient immaturity of the liver. This causes a short-term delay in ability to produce UDPG-transferase for conjugation. In addition, there is higher turnover of neonatal erythrocytes shortly after birth in order to replace fetal hemoglobin (Hb F) with hemoglobin A. This causes an increase in supply of heme for degradation to bilirubin. The reference ranges listed in Test Methodology 7-3 show the slight increase in bilirubin in the first few days of life when compared to the normal adult bilirubin level. This peaks at around 2 to 4 days but may remain elevated for up to 2 weeks.9

Naturally Occurring Regulatory T Cells

Recently the focus has been largely on naturally occurring CD4+ T cells constitutionally expressing the a chain of the IL-2 receptor (CD25) for a review see (Shevach 2002). Even though CD25- regulatory T cells exist (Apostolou et al. 2002 Lehmann et al. 2002), the CD25 marker has been used to define the properties of regulatory cells. The regulatory population was first identified as a subset of CD4+ T cells able to prevent the development of organ-specific autoimmune disease in mice thymectomized on day 3 after birth (Asano et al. 1996 Sakaguchi et al. 1995). Subsequently, the regulatory T cells have been shown to inhibit many autoimmune diseases (Shevach 2000 von Herrath et al. 2003), transfer tolerance to alloantigens (Taylor et al. 2001), hinder antitumor immunity (Shimizu et al. 1999) and regulate the expansion of other

Cytokine Requirements for the Control of Colitis by CD4CD25 Treg

Ex vivo (Asano et al. 1996) as well as direct secretion of these cytokines by the CD4+CD25+ T cells when stimulated in an appropriate fashion (Nakamura et al. 2001). We know that IL-10 plays an important function in the intestinal homeostasis, revealed by the fact that IL-10-deficient mice (Rennick et al. 2000) orwildtype mice treated with anti-IL-10R (Asseman et al. 2003) develop chronic inflammation in the intestine and IL-10 in general plays a role as a negative regulator of the immune response. In addition, administration of exogenous IL-10 inhibits the development of colitis in SCID mice reconstituted with CD4+CD45RBhigh T cells (Powrie et al. 1994) as well as in other models of IBD (Leach et al. 1999). Consistent with these studies, CD4+CD45RBhigh T cells isolated from transgenic mice, which expressed IL-10 under control of the IL-2 promoter, failed to induce colitis in SCID mice and were able to inhibit the disease when transferred with CD45RBhlgh CD4+ T cells from normal mice....

Energy Protein and

In the second half of pregnancy, protein needs almost double - the average woman requiring 40-50 g day before pregnancy now requires 70-90 g day.4 The choice of dietary fat is important. A pregnant woman's diet should be rich in the omega-3 fatty acids, eicosapenta-noic acid (EPA), and docosahexanoic acid (DHA). These fatty acids are important components of the developing baby's central nervous system and eyes. Because most of the cells in the central nervous system are formed during pregnancy and the first year after birth, ample intakes of EPA and DHA are vital during this period.5 Although adults are able to synthesize some EPA and DHA from li-nolenic acid (see pp.89), the fetus cannot because the necessary metabolic pathways have not fully developed. These fatty acids need to be supplied to the fetus by the mother.

Age and Gender Related Differences

Many studies report higher BNP and NT-proBNP concentrations in women, and a concurrent increase with age in both genders (see Fig. 4 8,12,19-22). This variation by age and gender is mediated in part by mild renal impairment, left ventricular hypertrophy, and abnormal systolic and diastolic cardiac function (22). Nevertheless, studies that excluded subjects with any measurable renal dysfunction and even subtle evidence of diastolic dysfunction have shown age and gender differences in BNP and NT-proBNP to remain. The physiological basis for these differences is not yet clearly defined. However, observations from several settings provide some clues as to potential contributors. For example, there are no significant variations in BNP plasma concentrations throughout the menstrual cycle (23). However, increased plasma BNP levels have been reported in the last trimester of pregnancy and in the immediate puerperium (24). In healthy neonates, BNP and NT-proBNP concentrations are much higher...

Production by Lung Hyaluronidases

The content of both HA and hyaluronidase in the chick embryo lung change with development (60), and in humans HA is higher in fetal lung than it is after birth or in adult lung (61). Hyaluronidase activity also changes, showing a rapid increase in rat lung immediately after birth (62). Presumably, the removal of HA is necessary to lower the water content of the lung, with which HA has a direct correlation (8,9), in order to facilitate breathing in air.

Clinical Features

The disease presents a few weeks after birth with feeding difficulties, lethargy, hypotonia, hypothermia, and seizures. Psychomotor development is markedly delayed, and death usually occurs within 1 to 2 years of onset. Somatic, vascular, and bony changes are characteristic. The infant's hair is short, stringy, wiry, often white, and, under the microscope, appears twisted. The skin is pale and thick or pasty. The blood vessels, as revealed by angiogram or at autopsy, are elongated, tortuous, and display focal luminal narrowing and dilations resulting from disruption and fragmentation of the elastic layer. The bone shows osteoporosis and an irregular lucent trabecular pattern on radiographs.

Congenital Adrenal Hyperplasia


In addition to being precursors of cortisone, many of the early intermediates are also estrogenic compounds. In the presence of abnormally high production of androgens, secondary sexual characteristics are affected. If this condition is manifested in utero, pseudohermaphroditism (masculinzation) of external genitalia occur in girls and macrogentisomia praecox (accentuation of male genitalia) occurs in boys. If the condition is not manifested until after birth, virilism (masculinization) develops in girls and precocious puberty in boys. In CAH variants IV, V, and VI, there is also some degree of interruption of the adrenal pathway, so that the external appearance of the female genitalia is not significantly affected and subsequent virilization is minimal or absent.

The development of the heart

Detailed Heart Diagram Ductus Venosus

The two overlapping defects in the septa form the valve-like foramen ovale which shunts blood from the right to left heart in the fetus (see 'fetal circulation' below). After birth, this foramen usually becomes completely fused leaving only the fossa ovalis on the septal wall of the right atrium as its memorial. In about 10 of adult subjects, however, a probe can still be insinuated through an anatomically patent, although functionally sealed foramen. At birth, the septum primum and septum secundum are forced together, closing the flap valve of the foramen ovale. Fusion usually takes place about 3 months after birth. In about 10 of subjects, this fusion may be incomplete. However, the two septa overlap and this patency of the foramen ovale is of no functional significance. If the septum secundum is too short to cover the foramen secundum in the septum primum, an atrial septal defect persists after the septum primum and septum secundum are pressed together at birth. This results in an...

The Gelsolin Family Of Calciumbinding Proteins

Gelsolin shows a definable pattern of expression in the developing CNS. It is found predominantly in oligodendrocytes and Schwann cells. It is also found in the myelin sheath. In oligodendrocytes, gelsolin is found in the soma and in cultured cells it is detectable in the branched cell processes (Lena et al. 1994). The protein is detectable in the brain of newborn rats. The expression of gelsolin gradually increases at 8 to 10 days after birth, reaching a maximum at 20 to 30 days when myelin formation is actively occurring. However, subsequently, its levels decrease even though myelin basic protein levels continue to rise until 6 months after birth. In Schwann cells gelsolin is found in the cytoplasm and in compact myelin (J. Tanaka and Sobue, 1994). It would appear therefore that gelsolin may be involved in the wrapping of myelin sheaths around the axons by promoting a process of motility generated by means of its effects on the cytoskeleton (J. Tanaka and Sobue, 1994 Lena et al....

Results And Discussion

Light microscopic visualization of proliferating cells in the postnatal rabbit cerebellum by the in vivo BrdU labeling procedure described in the Protocols section. After 1 hour survival, labeled nuclei are detected mainly in the EGL both in P0 (A) and P5 (B) animals. Scattered positive nuclei are also apparent in the ML and IGL. Panel C shows the pattern of labeling in a P5 animal which received an injection of the marker immediately after birth. Note labeled nuclei in the inner (premigratory) part of the EGL and positive nuclei in the ML, which likely correspond to newly generated granule cells during the route of their migration to the IGL. Scattered positive cells are also detected in the WM. Abbreviations BrdU, 5-bromodeoxyuridine EGL, external granular layer IGL, internal granular layer ML, molecular layer P0, postnatal day 0 P5, postnatal day 5 WM, white matter. Scale bars 100 pm.

Clinical Approach

When a young woman presents with primary amenorrhea, the differential diagnosis can be narrowed based on whether or not normal breast tissue is present, and whether a uterus is present or absent. After pregnancy is excluded, the two most common etiologies that cause primary amenorrhea associated with normal breast development and an absent uterus are androgen insensitivity syndrome and miillerian agenesis (Table 45-1).

Treatment Of Gingival Enlargement In Pregnancy

Before And After Gingival Enlargement

(iingival lesions in pregnancy should be treated as soon as they are detected, although not necessarily by surgical means. Scaling and root planing procedures and adequate oral hygiene measures may reduce the size of the enlargement. (iingival enlargements do shrink after pregnancy, but they usually do not disappear. Alter pregnancy, the entire mouth should be reevaluated, a lull set of radiographs taken, and the necessary treatment undertaken.

Genomic Signature Induced by hCG and Pregnancy

Fig. 7 Cluster analysis of rat mammary gland gene expression during and after pregnancy and hCG. (Reprinted with permission from J. Russo and I.H. Russo 2004) Fig. 7 Cluster analysis of rat mammary gland gene expression during and after pregnancy and hCG. (Reprinted with permission from J. Russo and I.H. Russo 2004)

Test Methodology 1210 Optical Density Of Amniotic Fluid

On the basis of the PG test in an amniotic fluid specimen, Ms. Johnson's fetus appeared to have adequate lung maturity, and labor was induced to prevent influx of additional maternal antibody because of erythroblastosis fetalis. Ms. Johnson delivered a small baby girl. After birth, the baby's hyperbilirubinemia was treated with phototherapy. Since bilirubin levels approached 16 mg dL, exchange transfusion was accomplished by withdrawing damaged blood and replacing it with donor blood in small amounts. Although the newborn did not develop respiratory distress syndrome, she was also monitored closely for adequate oxygenation during the first 3 days of her life.

Progestogenonly Contraception

The progestogens used (alone) orally include norgestrel, levonorgestrel, ethynodiol, norethisterone, desogestrel (e.g. Noriday, Micronor, Femulen). Medroxyprogesterone (Depo-Provera) (t 28 h) is a sustained-release (aqueous suspension) deep i.m. injection given 3-monthly. When injected between day 1 and day 5 of the menstrual cycle, contraception starts immediately. If given after day 5, a barrier contraceptive is needed for 7 days. Depo-Provera can be started within 5 days of childbirth or abortion however, starting it so soon after childbirth may cause heavy bleeding and so waiting until 6 weeks postpartum is probably better.

Gonadal Toxicity Following Malignancy Treatment

Unlike male germ cells, female germ cells proliferate only during prenatal life after birth, these progressively decrease in number due to apoptosis, and ovulation. Germ cells inside the female gonad do not proliferate, whereas the somatic cells do. Radiation and chemotherapy induce oocytes to undergo apoptosis, which reduces the number of germ cells,18 resulting in estrogen insufficiency. Therefore, when follicles are destroyed by cytotoxic therapy, the frequency of menses decreases and amenorrhea commonly occurs. Irreversible ovarian failure and menopause occur if the number of follicles falls below that is required for menstrual cyclicity.

Candidates for HCV Vaccine

Appropriate candidates for a HCV vaccine may include newly identified injection drug users or intranasal cocaine users, renal failure patients at risk for hemodialysis, patients with blood-clotting disorders, and other recipients of multiple blood products, the sex partners of HCV-infected individuals, and possibly sex workers. Patients with other chronic liver diseases would be targeted, as well. Although the prevalence of infection appears to be low in health care personnel, those regularly exposed to blood and body fluids might be considered for immunization. If early administration, e.g., shortly after birth, of a HCV vaccine to the neonates of infected women could protect the neonates, then identification pre-delivery of pregnant HCV-infected women would become critically important. Because vaccine delivery to injection drug users early in their careers remains problematic, it seems likely that a targeted approach to high-risk individuals is likely to fail. If this concept is...

Social and Other Biological Behaviors

Generally, many of our behavioral characteristics are learned throughout our life, with some abilities that are genetically coded and improved through our life experience. Some animals have some abilities that are far superior to those of humans, and these are coded into their genetics. For example, babies of migratory animals begin walking without assistance or guidance minutes after birth. While the baby depends on its mother for milk for survival, it is equipped with extensive other abilities that are critical to its survival including seeing, hearing, running, recognizing danger, and even the capability of passive self-defense. Inspired by these characteristics, robots are increasingly being developed with autonomous operations and programmed with social abilities to interact with humans (Breazeal, 2004). Learning to make realistic robots with social skills can have many important benefits including understanding behavior in humans and providing a cure to certain phobias. Recent...

Anatomical and Biological Imperatives

After pregnancy, the mother continues to nourish her child through breastmilk energy now synthesized and stored in the breast. Breastmilk, a living fluid that benefits infants, mothers, and society, changes throughout lactation to meet the infant's nutriment needs. No human-made substitute nourishes the infant as well.

Cells Of Origin For Gliomas

Recently, studies were begun to study the function of gene in CNS progenitors using conditional mutants. This is particularly useful for genes that lead to embryonic lethality when all somatic cells are in the homozygous deficient state. Using the cre loxP recombinase system, mice were generated lacking PTEN in nestin-expressing cells (109). These mice die shortly after birth, and their brains show a proportional increase in overall brain structures with altered histology in cortex, hippocampus, and cerebellum. Cells in the ventricular zone show an increase in BRDU staining, consistent with a decrease in cell-cycle time, and a decreased apoptosis (109). Cell fate commitment of progenitor cells was not affected in these mice. Thus, PTEN regulates the proliferation of the neural stem progenitor cells in vivo. Similar studies were also carried out expressing the cre recombinase under the control of GFAP promoter and enhancer (7,168). Unexpectedly, PTEN deletions were noted in neural...

TABLE 1716 Pathologic Findings of Some Common Congenital Cardiac Defects Heart Murmurs

Some heart murmurs reflect underlying heart disease. If you understand the physiologic causes for these heart murmurs, you will more readily be able to identify them and distinguish them from innocent heart murmurs. Obstructive lesions are caused by normal blood flow through valves that are too small for normal flow. Since this problem is not dependent on the drop in pulmonary vascular resistance that occurs following birth, these murmurs are audible at birth. Defects with left-to-right shunts, on the other hand, are dependent on the drop in pulmonary vascular resistance and are, therefore, not heard until a week or more after birth in

Composition of Term and Preterm Milk During the First Month of Lactation

Human milk is a good source of vitamin A (200 IU dl), which is present mainly as retinol (40-53 ng dl). Required for vision and maintenance of epithelial structures, vitamin A is at highest levels in the first week after birth and then gradually declines. Deficiency of vitamin A is a serious health problem for young children in many developing countries, leading to blindness through damage to the corneal epithelium (xe-rophthalmia) and to increased morbidity from infectious diseases. The prolongation of even partial breastfeeding provides an important source of vitamin A to children in developing countries (Bates & Prentice, 1994). Vitamin K. Vitamin K, which is required for the synthesis of blood-clotting factors, is present in human milk in small amounts. A few days after birth, a baby normally produces vitamin K in sufficient quantities by enteric bacteria. However, neonates are susceptible to vitamin K deficiency until ingestion of copious amounts of breastmilk can...

Physiological Control of Ghrelin Secretion

In humans, ghrelin secretion has been reported to occur throughout the lifespan, with some age-related variations. In particular, ghrelin secretion significantly increases after birth, peaking during the first two years of life, then decreases until the end of puberty 37 . Moreover, a further decrease of ghrelin levels in elderly subjects has also been reported recently 38 .

Annexins And Diabetes

Further evidence for a role of annexins in diabetes comes from one study of a heterozygous annexin 7 knock-out mouse. In this study the annexin 7 null mouse was found to be embryonic lethal at day 10 but the heterozygote was viable and fertile. The heterozygous mice have enlarged islets of Langerhans with an 8-10 fold increase in vesicle insulin content at 6 weeks after birth. Abnormal calcium-mediated insulin secretion was observed in heterozygotes with a reduction in insulin secretion of 67 at 1mM Ca2+, and a higher level of secretion at high calcium concentration 5mM Ca2+. This was attributed to a decrease in the amount of IP3 receptors in the heterozygotes that was confirmed by electron microscopy (Srivastava, 1999). These results however have not been reproduced in another annexin 7 knockout mouse which appears to have no defects in insulin metabolism

Clinical Implications Mother

Breast Pinch

Encouraging early and frequent breastfeeding is a simple, low-cost recommendation for breastfeeding initiation. If the infant is able to suckle effectively at the breast soon after birth, there is a direct relationship between the frequency and strength of suckling and subsequent availability of breastmilk. There appears to be an early window of opportunity for the infant's suckling to stimulate prolactin receptors (discussed earlier in this chapter), which in turn enhances milk production. A basic knowledge of anatomy and physiology is put to valuable use when the lactation consultant or nurse translates basic concepts into easily understandable teaching materials. If a client realizes a stressful environment

Role Of Ets In Cancer And Disease

The ETS2 gene is expressed in most cell types, whereas ETS1 and FLI1 gene expression are tissue specific 3-6 . Expression of these genes in multiple tissues during embryonic development suggests that these genes may be required for multiple functions during critical stages of organogenesis. ETS1 expression is detected at around 8 days post conception (dpc). During embryogenesis, ETS1 expression is detected in lymphoid tissues, as well as several other organ systems (mostly in cells of mesodermal origin). ETS 1 gene expression in the thymus begins to appear two days before birth, coinciding with the appearance of mature (single positive) thymocytes. Expression of ETS1 is restricted primarily to lymphoid cells after birth. In contrast, ETS2 expression is more ubiquitous. While ETS2 expression is distinctly different from that of ETS1 during embryonic development and in the adult, FLI1 expression is similar to ETS1. Expression patterns during embryogenesis suggest that FLU may function...

Newborn And Early Infancy

Does Angel Kiss Baby Eyelids Fade

The newborn infant's skin has a unique characteristic texture and appearance. The texture is soft and smooth because it is thinner than the skin of older children. Within the first 10 minutes after birth, a normal newborn progresses from generalized cyanosis to pinkness. In lighter-skinned infants, an erythematous flush, giving the skin the appearance of a boiled lobster, is common during the first 8 to 24 hours, then the normal pale pink coloring predominates. Inspect the newborn closely for a series of common skin conditions. At birth, a cheesy white material called vernix caseosa, composed of sebum and desquamated epithelial cells, covers the body. Some newborns have edema over their hands, feet, lower legs, pubis, and sacrum this disappears within a few days. Superficial desquamation of the skin is often noticeable 24 to 36 hours after birth. You should be able to identify four common dermatologic conditions in newborns. None is clinically significant. Milia, pinhead-sized smooth,...

The Role of Breast Architecture and the Pathogenesis of Breast Cancer

1970 Trapido 1983 Vessey et al. 1985) indicates that Lob 1 in these two groups of women might be biologically different or exhibit different susceptibility to carcinogenesis (J. Russo et al. 1989, 1992, 1993, 1994, 2000). Even though the Lob 1 is the hallmark of the postmenopausal breast, we postulate that the degree of differentiation acquired through early pregnancy has caused a genomic signature that differentiates the Lob 1 from the early parous women from that of the nulliparous women by shifting the Stem cell 1 to a Stem cell 2 that is refractory to carcinogenesis (Fig. 2). This is supported by recent data obtained in the rat model (J. Russo and I.H. Russo 1997) in which a cluster of genes remain activated in the involuted gland after pregnancy, conferring a special genomic signature to the gland that is responsible for its refractoriness to chemical car-cinogenesis. Thus the refractoriness is produced by the shifting of the compartments of Stem cells 1 to other stem cells...

Assessment Of Newborns

A number of techniques help you assess the developmental level of newborns. These techniques are often part of a limited-screening pediatric physical examination performed immediately after birth. Life. Examining newborns immediately after birth is important for determining the general condition, developmental status, abnormalities in gesta-tional development, and presence of congenital abnormalities. The examination may reveal diseases of cardiac, respiratory, or neurologic origin. Listen to the anterior thorax with your stethoscope, palpate the abdomen, and inspect the head, face, oral cavity, extremities, genitalia, and perineum. Apgar Score. The Apgar score is the key initial assessment of the baby immediately after birth. It contains five components for classifying the newborn's neurologic recovery from the birth process and immediate adaptation to extrauterine life. Score each newborn according to the following table, at 1 and 5 minutes after birth. Scoring is based on a 3-point...

Milk Synthesis and Maturational Changes

Arthur, Smith, and Hartmann (1989) and Hu-menick (1987) have proposed two different biological markers as objective measures to define stages of breastmilk maturation. Arthur, Smith, and Hartmann hold that in the first stage of lactogen-esis, average concentrations of lactose, citrate, and glucose are low. A sudden and rapid increase in concentrations of these components between 24 to 48 hours after birth heralds the transition from stage I to stage II lactogenesis. Stage II lactogen-esis markers (lactose, citrate, and total nitrogen) take an additional 24 hours to attain concentration in women who have insulin-dependent diabetes Humenick et al. (1994), on the other hand, consider the breakdown of an emulsion dependent on the ratio of sterols plus phospholipids to fat content of milk (maturation index of colostrum and milk MICAM ) as the biological marker for breastmilk maturation (Figure 4-1). Both of these methods appear to be valid in that they were positively related to greater...

Historical Context

The main topic Walker addresses in Possessing the Secret of Joy is how the female genital mutilation ritual in a specific African tribe affects the mind, body, and spirit of its bicultural protagonist, her family, and her countries. However, it is necessary to note that Walker's literary representation of FGM applies to only a small percentage of African tribes and that the surgical ritual is conducted in many different ways, in hospitals as well as in huts, for many different reasons. For these general purposes, the procedure is more descriptively called female genital cutting (FGC) because, by degree, it ranges from a slight ceremonial nicking of the clitoris to draw blood to the more radical excision (removing some or all of the outer genitals) and infibulation (sewing up the vagina and leaving a small opening for urination and menstrual flow). The ritual's end result spans the gamut from a proud youth who has experienced a spiritual initiation into adulthood and elevated tribal...


In the early stage of embryogenesis, blood cells arise from the yolk sac, and later from the liver and spleen. During the later stages of embryogenesis, and after birth, the bone marrow is the hematopoietic tissue that gives rise to most mature nonlymphoid blood cells including monocytes, granulocytes, eosinophils, basophils, erythrocytes, and platelets. These blood cells have a relatively short life span and are replaced continuously by progeny of self-renewing pluripotent stem cells, a process termed hematopoiesis. Under the influence of cytokines, and other factors produced by bone marrow stromal cells, blood cells go through distinct stages of differentiation and maturation before being released into the blood. Soluble mediators that have been shown to play a role in hematopoiesis include c-kit ligand, interleukin-3 (IL-3), interleukin-7 (IL-7), and the colony stimulating growth factors (CSF) G-CSF, M-CSF, and GM-CSF (G granulocyte, M monocyte).

Infants and neonates

Very young infants have similar problems of inability to communicate. Often, if born prematurely, or with some health problem occurring soon after birth, there is the need to perform painful interventions and surgery. Even pre-term infants have nervous systems developed in order to sense and experience pain (e.g. Anand and Hickey 1987 Torres and Anderson 1985). There is no doubt that these very young infants have some experience which echoes the adult experience of pain. There is not the language or experience or learning to help to explain or give meaning to the experience.

Fetal Growth

Many LBW infants do not catch up after birth even with adequate nutrition after birth, most will be shorter than average for the rest of their lives, and many show long-term impairments in intellect and mental development. In addition, LBW infants tend to have more chronic health problems in later life. Thus, poor nutrition in utero may have profound effects that cannot be reversed after birth. A multivitamin mineral supplement taken during pregnancy may decrease risk of delivering a LBW infant.3


In infants, the disease manifests soon after birth with progressive muscle weakness and firmness, cardio-myopathy, and macroglossia. Death, usually from cardiac failure, occurs within 1 to 2 years. A myopathic EMG pattern and the presence of discrete cytoplasmic vacuoles in the circulating lymphocytes are helpful diagnostic clues. The neuronal glycogen storage is ubiquitous and particularly prominent in the spinal cord and brain stem. Astrocytes store glycogen in the cerebral hemispheric white matter (Fig. 9.9).


Vitamin K is important during the newborn period for normal blood clotting. However, the infant requirement for vitamin K cannot be met by usual levels in breast milk. Poor vitamin K status can lead to hemorrhagic disease of the newborn. Therefore, to prevent bleeding problems and provide adequate body stores, newborns often receive a single dose of 0.5-1 mg of vitamin K soon after birth.

AtRisk Groups

Pneumonia can occur in up to 10 of pregnant women with chicken pox, and the severity is increased in later gestation (34). They can also transmit infection to the unborn baby (35). If infection is acquired in the first 20 weeks, there is a less than 3 chance of it leading to congenital Varicella syndrome. Infection in the last trimester can lead to neonatal Varicella, unless more than 7 days elapse between onset of maternal rash and delivery when antibodies have time to cross the placenta leading to either mild or inapparent infection in the newborn. In this situation, Varicella immunoglobulin (VZIG) should be administered to the baby as soon as possible after birth (36).


The role of astrocytes begins during brain development, when the radial astrocytes guide the migrating neurons. After birth, the astrocytes are important in a number of physiologic processes They provide support and nutrients to the neurons, protect them from excitotoxic neurotransmitters, contribute to the blood-brain barrier, and maintain homeostasis in the extracellular compartment.


Hyperammonemia presents shortly after birth with lethargy, vomiting, alkalosis, temperature abnormalities and, if not treated, death ensues from cerebral edema. Partial enzyme deficiencies are prone to cause episodic encephalopathies that can be precipitated by high protein intake, infection, and treatment with valproate.


The hymen is the tissue that partially or completely surrounds the opening of the vagina. It appears that all females have hymenal tissue present at birth (91). The hymen may be annular (encircling the vaginal opening), cres-centic (present at the lateral and posterior margins), fimbriated (frilly edged), or, usually after childbirth, present only as interrupted tags or remnants. It is important that the reader refer to atlases that illustrate these variations (2,92). There is usually a single opening in the hymen. Uncommon congenital variants include two or more hymenal openings, referred to as septate or cribriform, respectively, and, rarely, complete absence of an opening (imperforate hymen).


The disease presents soon after birth with prolonged jaundice, vomiting, diarrhea, hepatomegaly, and anemia. Untreated patients develop ocular, neurologic, visceral, and metabolic disorders hepatomegaly progressing to nodular cirrhosis kidney dysfunction hypoglycemic episodes and lenticular cataract. Mental retardation, seizures, extrapyramidal and cerebellar symptoms, and microcephaly are chief neurologic features. The dietary elimination of galactose (lactose-containing products) prevents the development of complications, provided it is initiated a few days after birth and continued throughout life.

Vaginal Structure

Vagina Rugous

A stratified squamous epithelium lines the vagina and the vaginal cervix it contains no glands and is lubricated partly by cervical mucus and partly by desquamated vaginal epithelial cells. In nulliparous women the vaginal wall is rugose, but it becomes smoother after childbirth. The rugae of the The nulliparous external os is circular but after childbirth it becomes a transverse slit with an anterior and a posterior lip.

The vulva

The vaginal orifice is guarded in the virgin by a thin mucosal fold, the hymen, which is perforated to allow the egress of the menses, and may have an annular, semilunar, septate or cribriform appearance. Rarely, it is imper-forate and menstrual blood distends the vagina (haematocolpos). At first coitus the hymen tears, usually posteriorly or posterolaterally, and after childbirth nothing is left of it but a few tags termed carunculae myrtiformes.


Monozygotic (identical) twins share a common genetic inheritance. They are occasionally separated at or shortly after birth and they often share a common fate in their separate geographical locations. These coincidences are often reported in the newspapers and might be dismissed as popular myths, but scientific studies also exist. Dr. Bouchard of the University of Minnesota surveyed the lives of separated monozygotic twins and found cases like that of James Springer and James Lewis. Each adopting couple believed that the other baby

Germ Cell Tumors

After the development of puberty, while ovarian GCTs in females can occur anytime after birth and are much more common in preadolescents. Genetic analysis of ovarian GCTs that present in the second decade of life reveal isochromosome 12p, the characteristic cytogenetic abnormality found in testicular GCT 1315 . Biologic studies from early co-operative pediatric GCT trials showed that such cytogenetic aberrations were age-dependent. Chromosome I(12p) abnormality has been reported 16 in tumors from pubertal and postpubertal males, but the most common abnormalities in prepubertal females in order of prevalence were gains of 1q, +14, +8, +12, +2, +3, and +7.

Hepatitis B

They should also be immunized with the HBV vaccine at d 1, mo 1, and mo 6 after birth (16). Side effects of the vaccine are uncommon, and include irritability, mild fever, and local irritation at the injection site. Available data suggest that the rate of perinatal transmission of HCV is not related to the route of infant delivery, i.e., vaginal delivery or cesarean section. In Germany, however, Hillemmans et al. (25) found that infants born by cesarean section, to mothers who were HCV antibody-positive, had a twofold risk of being antibody-positive after birth. Of this group of infants, 3.4 remained HCV PCR-positive 12 mo postpartum.

The Future

Medical Success and a Setback with SCID Relevance Children with severe combined immunodeficiency disease (SCID) show an almost 20.1 complete failure to fight infection and die soon after birth if not kept in sterile conditions. SCID is more widely known as bubble boy disease because confinement to a germfree plastic bubble was the way in which patients were kept alive for a number of years. One rare form of SCID, caused by a failure to make an enzyme called adenosine deaminase, can be treated by regular injections of recombinant protein (page 149). In 1990 the first trial of a genetic therapy began at the National Institutes of Health in Washington. White blood cells from patients were transfected with a plasmid encoding adenosine deaminase, which inserted into random positions in the genome and began to be transcribed. Although the therapy does seem to have helped the patients, they still need to be periodically injected with recombinant adenosine deaminase.


Marsupials are mammals whose embryos develop within the mother's uterus for a short period of time before birth. After birth the immature babies crawl into the mother's abdominal pouch where they complete their development. Animals such as the kangaroo, opossum, and koala bear are marsupials.

Milk Production

And numerous other substances from the mother's blood, converting them to milk for her infant. Stores of adipose tissue laid down during pregnancy are drawn upon to provide substrate for milk synthesis. When the milk comes in or rapidly increases in volume, creating breast fullness 3 to 4 days after birth, closure of the junctional complexes between the mammary alveolar cells prevents direct access of extracellular space to the lumen of the mammary alveoli (Neville, 2001). Thus sodium, chloride, and lactose concentrations are altered. Mothers then begin to feel a tightening in their breasts as the myoepithelial cells contract to expel the milk (Color Plate 3). This physiologic response is known as letdown and also as mammary-ejection reflex.


Recessive human genetic disorder. The enzyme converting dietary phenylalanine to tyrosine is deficient, causing excretion of phenylpyruvate (or phenylalanine) in urine. Intellectual impairment common and epileptic attacks occur in about 25 of cases. Tendency to lighter hair and skin pigmentation than average. Can be detected soon after birth a diet low in phenylalanine reduces symptoms.


The capacity of the mammary gland to secrete milk from mid-pregnancy to late pregnancy is called lactogenesis, stage I (or lactogenesis I) (see again Table 3-1). During lactogenesis I, breast size increases as epithelial cells of the alveoli differentiate into secretory cells for milk production. Fat droplets accumulate in these cells and plasma concentration of lactose and a-lactalbumin increase. The milk droplets move through the cell membrane and into the ductules (see Figure 3-6). The onset of copious milk secretion after birth is lactogenesis, stage II (days 2 or 3 to 8 postpartum). During lactogenesis II, milk tain situations (as listed in Table 3-2), invites us to gain a better understanding of the specific biochemical or hormonal nature of lactogenesis that may lead to a delay in lactogenesis. We do know that high breastmilk sodium levels on or before the third day after birth are significant for impending breastfeeding problems and for lactation involution (Morton, 1994...