We previously observed an association between mode of delivery and brain mitochondrial mechanisms in pups. We also showed that mitochondrial processes impact adult behavior. However, no experimental data is available to causally connect mode of delivery with cellular processes of neurons in the cerebral cortex and adult behavior. Here we show that surgical delivery of pups alters mitochondrial dynamics and spine synapses of layer 3 pyramidal neurons of the prefrontal cortex compared to the values of mice delivered vaginally. These alterations in ultrastructure seen in adult mice delivered surgically were associated with the development of behavioral phenotypes resembling those characteristic of animal models of psychiatric illness. This included impaired performance in prepulse inhibition as well as hyperlocomotion in the open field and elevated plus maze tests. Knocking out a mitochondria-related gene, UCP-2, blocked cellular and behavioral adaptations induced by surgical delivery. These results highlight a crucial role for brain mitochondrial adaptations in the process of birth to affect neuronal circuitry in support of normal and altered adult behaviors. Further, these findings were supported with neuroimaging data from human neonates delivered vaginally and surgically, suggesting that the murine findings have human clinical relevance.
Ovarian absence is an uncommon condition that most frequently presents unilaterally. Several etiologies for the condition have been proposed, including torsion, vascular accident, and embryological defect. A systematic review was conducted to describe the clinical presentation of ovarian absence, as well as its associations with other congenital anomalies, through a systematic search of Cochrane Library, ClinicalTrials.gov, Google Scholar, Ovid Embase, Ovid Medline, PubMed, Scopus, and Web of Science. Exclusion criteria included cases with suspicion for Differences of Sex Development, lack of surgically-confirmed ovarian absence, and karyotypes other than 46XX. Our search yielded 12,120 citations, of which 79 studies were included. 10 additional studies were found by citation chasing resulting in a total 113 cases including two unpublished cases presented in this review. Abdominal/pelvic pain (30%) and infertility/subfertility (19%) were the most frequent presentations. Ovarian abnormalities were not noted in 28% of cases with pre-operative ovarian imaging results. Approximately 17% of cases had concomitant uterine abnormalities, while 22% had renal abnormalities. Renal abnormalities were more likely in patients with uterine abnormalities (p < 0.005). Torsion or vascular etiology was the most frequently suspected etiology of ovarian absence (52%), followed by indeterminate (27%) and embryologic etiology (21%). Most cases of ovarian absence are likely attributable to torsion or vascular accidents, despite many references to the condition as “agenesis” in the literature. Imaging may fail to correctly diagnose ovarian absence, and diagnostic laparoscopy may be preferable in many cases as genitourinary anatomy and fertility considerations can be assessed during the procedure. Fertility is likely minimally or not affected in women with unilateral ovarian absence.
OBJECTIVE: Data suggest type O blood has a higher propensity for hemorrhage, although the literature on postpartum hemorrhage (PPH) is mixed and does not separate by mode of delivery. Our objective was to assess the relationship between PPH and ABO blood type by mode of delivery. STUDY DESIGN: This is a retrospective cohort study of all singleton gestations delivered after 34 weeks identified by the PeriBank database of Baylor College of Medicine January 2011-March 2018. Exclusion criteria were sickle cell disease, use of anticoagulant medications other than Aspirin 81 mg, and multiple gestations. Data were abstracted from the PeriBank regarding demographics and delivery outcomes. Analyses were conducted separately for cesarean delivery (CD) and vaginal delivery (SVD). Significant demographic differences between groups were controlled for in multivariate logistical regression. Quantitative variables were analyzed with ANOVA and categorical variables with chi squared. The primary outcome was the rate of PPH by blood type (A, B, AB, and O), defined as blood loss >500 cc in SVD and >1000 cc in CD. RESULTS: 32,023 women met inclusion criteria (SVD 22,484 (70.2%), CD 9,539 (29.8%)). Significant demographics differences between blood types included age, parity, race, induction of labor, regional anesthesia, and thrombocytopenia in the SVD group. In the CD group, age, parity, and race were significantly different between blood types. There was no observed difference in the rate of PPH by blood type for those who delivered via SVD (p¼0.4), including when controlling for demographic differences in logistic regression (p¼0.2). In the CD group, there was a significantly higher rate of PPH in women with type O blood (5.2% type O vs 3.8% type A vs 4.4% type B vs 4.2% type AB, p¼0.035), including when controlling for demographic differences (p¼0.02). In both SVD and CD groups, there was no difference in any of the secondary outcomes including blood transfusions, hysterectomies, intrapartum D+C, and ICU admission. CONCLUSION: Type O blood may be an additional risk factor for PPH at the time of CD.
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