scholarly journals Caesarean section and its relationship to offspring general cognitive ability: a registry-based cohort study of half a million young male adults

2021 ◽  
pp. ebmental-2021-300307
Author(s):  
Viktor H Ahlqvist ◽  
Lucas D Ekström ◽  
Egill Jónsson-Bachmann ◽  
Per Tynelius ◽  
Paul Madley-Dowd ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cognitive Ability ◽  
Large Scale ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Cognitive Test ◽  
General Cognitive Ability ◽  
Adult Males ◽  
Birth Registry ◽  
Swedish Population

BackgroundA relationship between caesarean section and offspring cognitive ability has been described, but data are limited, and a large-scale study is needed.ObjectiveTo determine the relationship between mode of delivery and general cognitive ability.MethodsA cohort of 579 244 singleton males, born between 1973 and 1987 who conscripted before 2006, were identified using the Swedish population-based registries. Their mode of delivery was obtained from the Swedish Medical Birth registry. The outcome measure was a normalised general cognitive test battery (mean 100, SD 15) performed at military conscription at around age 18.FindingsMales born by caesarean section performed poorer compared with those born vaginally (mean score 99.3 vs 100.1; adjusted mean difference −0.84; 95% CI −0.97 to −0.72; p<0.001). Both those born by elective (99.3 vs 100.2; −0.92; 95% CI −1.24 to −0.60; p<0.001) and non-elective caesarean section (99.2 vs 100.2; −1.03; 95% CI −1.34 to −0.72; p=0.001), performed poorer than those born vaginally. In sibling analyses, the association was attenuated to the null (100.9 vs 100.8; 0.07; 95% CI −0.31 to 0.45; p=0.712). Similarly, neither elective nor non-elective caesarean section were associated with general cognitive ability in sibling analyses.ConclusionBirth by caesarean section is weakly associated with a lower general cognitive ability in young adult males. However, the magnitude of this association is not clinically relevant and seems to be largely explained by familial factors shared between siblings.Clinical implicationClinicians and gravidas ought not to be concerned that the choice of mode of delivery will impact offspring cognitive ability.

scholarly journals Postpartum femoral neuropathy: managing the next pregnancy

2019 ◽  
Vol 12 (12) ◽  
pp. e232967 ◽  
Author(s):  
Cathy Rowland ◽  
Daniel Kane ◽  
Maeve Eogan
Keyword(s):  
Caesarean Section ◽  
Motor Function ◽  
Lower Limb ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Primiparous Woman ◽  
Limb Weakness ◽  
Femoral Neuropathy ◽  
Lower Limb Weakness ◽  
Spontaneous Labour

A 34-year-old primiparous woman presented in spontaneous labour and had an unassisted vaginal birth of a 3.5 kg infant. Postnatally, the patient experienced lower limb weakness and was unable to mobilise unassisted. A diagnosis of postpartum femoral neuropathy was made. Full recovery of normal motor function was not achieved until 5 months postpartum. She returned in her next pregnancy, seeking advice on how to avoid this complication from reoccurring. It was decided that an elective caesarean section was an appropriate mode of delivery, which she underwent at 39 weeks without complication and without recurrence of the femoral neuropathy.

scholarly journals Identifying Nootropic Drug Targets via Large-Scale Cognitive GWAS and Transcriptomics

2020 ◽  
Author(s):  
Max Lam ◽  
Chen Chia-Yen ◽  
Xia Yan ◽  
W. David Hill ◽  
Joey W. Trampush ◽  
...  
Keyword(s):  
Cognitive Ability ◽  
Drug Targets ◽  
Large Scale ◽  
Drug Repurposing ◽  
Gene Identification ◽  
Summary Statistics ◽  
General Cognitive Ability ◽  
Nootropic Drug ◽  
Genome Wide ◽  
Meta Analyses

AbstractBackgroundCognitive traits demonstrate significant genetic correlations with many psychiatric disorders and other health-related traits. Many neuropsychiatric and neurodegenerative disorders are marked by cognitive deficits. Therefore, genome-wide association studies (GWAS) of general cognitive ability might suggest potential targets for nootropic drug repurposing. Our previous effort to identify “druggable genes” (i.e., GWAS-identified genes that produce proteins targeted by known small molecules) was modestly powered due to the small cognitive GWAS sample available at the time. Since then, two large cognitive GWAS meta-analyses have reported 148 and 205 genome-wide significant loci, respectively. Additionally, large-scale gene expression databases, derived from post-mortem human brain, have recently been made available for GWAS annotation. Here, we 1) reconcile results from these two cognitive GWAS meta-analyses to further enhance power for locus discovery; 2) employ several complementary transcriptomic methods to identify genes in these loci with variants that are credibly associated with cognition; and 3) further annotate the resulting genes to identify “druggable” targets.MethodsGWAS summary statistics were harmonized and jointly analysed using Multi-Trait Analysis of GWAS [MTAG], which is optimized for handling sample overlaps. Downstream gene identification was carried out using MAGMA, S-PrediXcan/S-TissueXcan Transcriptomic Wide Analysis, and eQTL mapping, as well as more recently developed methods that integrate GWAS and eQTL data via Summary-statistics Mendelian Randomization [SMR] and linkage methods [HEIDI], Available brain-specific eQTL databases included GTEXv7, BrainEAC, CommonMind, ROSMAP, and PsychENCODE. Intersecting credible genes were then annotated against multiple chemoinformatic databases [DGIdb, KI, and a published review on “druggability”].ResultsUsing our meta-analytic data set (N = 373,617) we identified 241 independent cognition-associated loci (29 novel), and 76 genes were identified by 2 or more methods of gene identification. 26 genes were associated with general cognitive ability via SMR, 16 genes via STissueXcan/S-PrediXcan, 47 genes via eQTL mapping, and 68 genes via MAGMA pathway analysis. The use of the HEIDI test permitted the exclusion of candidate genes that may have been artifactually associated to cognition due to linkage, rather than direct causal or indirect pleiotropic effects. Actin and chromatin binding gene sets were identified as novel pathways that could be targeted via drug repurposing. Leveraging on our various transcriptome and pathway analyses, as well as available chemoinformatic databases, we identified 16 putative genes that may suggest drug targets with nootropic properties.DiscussionResults converged on several categories of significant drug targets, including serotonergic and glutamatergic genes, voltage-gated ion channel genes, carbonic anhydrase genes, and phosphodiesterase genes. The current results represent the first efforts to apply a multi-method approach to integrate gene expression and SNP level data to identify credible actionable genes for general cognitive ability.

scholarly journals Vaginal Delivery versus Elective Caesarean Section for Breech Presentation - Experience in Institute of Child and Mother Health (ICMH)

2019 ◽  
Vol 31 (1) ◽  
pp. 23-26
Author(s):  
Mahe Jabeen ◽  
Sabiha Shimul ◽  
Ummay Salma ◽  
Jebunnesa
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Maternal Morbidity ◽  
Neonatal Outcome ◽  
Elective Caesarean Section ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Cost Of Care ◽  
Increased Risk

Introduction: Compared with a fetus with cephalic presentation, a breech fetus faces increased risk during labour and delivery of asphyxia from cord compression and of traumatic injury during delivery of the shoulders and head. Caesarean section avoids most of this risk. The purpose of this study was to evaluate the feasibility of vaginal delivery of uncomplicated singleton breech presentation by evaluating early neonatal morbidity and mortality as well as maternal morbidity following vaginal and caesarean delivery for breech presentation. Materials and Methods: This is a cross sectional comparative study.104 women with singleton breech presentation at term in labour were included consequetively in labour ward of Institute of Child and Mother Health (ICMH). Informed consent was taken from them. Neonatal and maternal outcome were recorded and statistical analysis was done using SPSS version 22. Results: APGAR at 5 min and Neonatal Intensive Care Unite (NICU) admission were not affected by mode of delivery. Long term neonatal outcome is similar in either mode of delivery. Maternal morbidity and duration of hospital stay is increased in caesarean births. Conclusion: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill & confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. Medicine Today 2019 Vol.31(1): 23-26

The relationship between hand preference, hand performance, and general cognitive ability

2010 ◽  
Vol 16 (4) ◽  
pp. 585-592 ◽  
Author(s):  
MICHAEL E.R. NICHOLLS ◽  
HEIDI L. CHAPMAN ◽  
TOBIAS LOETSCHER ◽  
GINA M. GRIMSHAW
Keyword(s):  
Cognitive Ability ◽  
Performance Measures ◽  
Large Scale ◽  
Hand Preference ◽  
Performance Measure ◽  
General Cognitive Ability ◽  
Preference Data ◽  
Hand Performance ◽  
The Relationship

AbstractThe idea that handedness indicates something about a person’s cognitive ability and personality is a perennial issue. A variety of models have been put forward to explain this relationship and predict a range of outcomes from higher levels of cognitive ability in left-handers or moderate right-handers to lower levels of achievement in left- or mixed-handers. We tested these models using a sample (n = 895) drawn from the BRAINnet database (www.brainnet.net). Participants completed a general cognitive ability (GCA) scale and a test of hand preference/performance. Moderate right-handers, as indexed by their performance measures, had higher GCA scores compared with strong left- or right-handers. The performance measure also showed lower levels of GCA for left-handers compared with right-handers. The hand preference data showed little or no association with cognitive ability—perhaps because this measure clusters individuals toward the extremes of the handedness distribution. While adding support to Annett’s heterozygous advantage model, which predicts a cognitive disadvantage for strong left- or right-handers, the data also confirm recent research showing a GCA disadvantage for left-handers. Although this study demonstrates that handedness is related to cognitive ability, the effects are subtle and might only be identified in large-scale studies with sensitive measures of hand performance. (JINS, 2010, 16, 585–592.)

scholarly journals An investigation of Social Class Inequalities in General Cognitive Ability in Two British Birth Cohorts

2018 ◽  
Author(s):  
Roxanne Connelly ◽  
Vernon Gayle
Keyword(s):  
Social Class ◽  
Cognitive Ability ◽  
Test Scores ◽  
Large Scale ◽  
Parental Education ◽  
General Cognitive Ability ◽  
Birth Cohorts ◽  
Ability Test ◽  
British Cohort Study ◽  
Nationally Representative

The ‘Flynn effect’ describes the substantial and long-standing increase in average cognitive ability test scores, which has been observed in numerous psychological studies. Flynn makes an appeal for researchers to move beyond psychology’s standard disciplinary boundaries and to consider sociological contexts, in order to develop a more comprehensive understanding of cognitive inequalities. In this article we respond to this appeal and investigate social class inequalities in general cognitive ability test scores over time. We analyse data from the National Child Development Study (1958) and the British Cohort Study (1970). These two British birth cohorts are suitable nationally representative large-scale data resources for studying inequalities in general cognitive ability.We observe a large parental social class effect, net of parental education and gender in both cohorts. The overall finding is that large social class divisions in cognitive ability can be observed when children are still at primary school, and similar patterns are observed in each cohort. Notably, pupils with fathers at the lower end of the class structure are at a distinct disadvantage. This is a disturbing finding and it is especially important because cognitive ability is known to influence individuals later in the lifecourse.

scholarly journals Conjoined Twins

2018 ◽  
Vol 56 (211) ◽  
pp. 708-710
Author(s):  
Pramod Kattel
Keyword(s):  
Caesarean Section ◽  
Apgar Score ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Conjoined Twins ◽  
Outpatient Department ◽  
Oxygen Supplementation ◽  
Neonatal Deaths ◽  
Early Neonatal Deaths

Reported here is a case of conjoined twins presented to ante-natal outpatient department of Paropakar Maternity and Women’s Hospital on 21st August 2015 on a 20 year “Primigravida at 27 weeks and 6 days of gestation not in labor” referred from a polyclinic following ultrasonography diagnosis for better management. After confirming the diagnosis and counseling the patients regarding mode of delivery and possible outcomes, elective caesarean section was performed and delivered male conjoined twins of Parapagus dicephalus type with poor Apgar score. No resuscitation attempted except oxygen supplementation as per wish of parents and early neonatal deaths occurred at one hour of life.  

Core surgical skills

2017 ◽  
Keyword(s):  
Caesarean Section ◽  
Clinical Skills ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Large Family ◽  
Antenatal Clinic ◽  
Normal Delivery ◽  
Breech Delivery ◽  
To Come ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … Sarah Bener is a 28- year- old lady in her second pregnancy. She has had an elective caesarean section in her last pregnancy for a breech delivery two years ago. She has no other health problems and her pregnancy has progressed well so far. She is currently 36 weeks pregnant and has presented to the antenatal clinic to discuss the mode of delivery. You have 10 minutes for this task (+ 2mins initial reading time) Please read instructions to candidate and actor. This station assesses the candidate’s ability to come to a shared decision after discussing the pros and cons of both the options. Please do not interrupt or prompt. Record your overall clinical impression of the candidate for each domain (e.g. should this performance be pass, borderline or a fail). You are Sarah Bener, a 28- year- old house wife. You are 36 weeks pregnant. You are healthy and so far your pregnancy had progressed smoothly. You feel good baby movements. The screening test as well as the baby’s scan at 20 weeks has been normal. You have one child, Imogen, born by caesarean section two years ago. It was an elective caesarean section as Imogen was in breech position. They did try turning her (ECV), but was unsuccessful. You were very much looking forward to a normal delivery and were disappointed that you needed a caesarean section. The caesarean section was straightforward, without any complications. But you needed a few days to recover at home. You are keen to have a normal delivery this time, but want to know the options and risks of the mode of delivery. Both you and your husband have always wanted a large family, so want to know the implications of a second section. If the candidate does not mention VBAC, say that you have heard of this and can they explain more about it.

scholarly journals Personal Preference of Mode of Delivery. What do Urogynaecologists choose? Preliminary Results of the DECISION Study

2017 ◽  
Vol 77 (11) ◽  
pp. 1182-1188 ◽  
Author(s):  
Julia Bihler ◽  
Ralf Tunn ◽  
Christl Reisenauer ◽  
Jan Pauluschke-Fröhlich ◽  
Philipp Wagner ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Risk Stratification ◽  
Pelvic Floor ◽  
Vaginal Delivery ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Online Questionnaire ◽  
Personal Attitude ◽  
Uncomplicated Pregnancy ◽  
Study Participants

Abstract Introduction Currently, almost every third child in Germany is delivered by caesarean section. Apart from straightforward and clear indications for caesarean section which account for approx. 10%, the large proportion of relative indications in particular needs to be critically reviewed if the current C-section rate is to be effectively lowered. It is more than doubtful, however, whether this can be a realistic goal in Germany, especially in the context of international developments. All studies on this topic demonstrate that the personal attitude of the obstetric team has a considerable influence on the pregnant womanʼs personally preferred mode of delivery. Therefore, in the first part of the DECISION study, the personal preferences of urogynaecologists were evaluated regarding the best suitable mode of delivery. Material and Methods All 432 delegates at the 9th German Urogynaecology Congress in Stuttgart in April 2017 were invited to participate in an online questionnaire study. The questionnaire was developed especially for this study. Results Of the 432 registered delegates, 189 (43.8%) participated in the survey. 84.7% (n = 160) of the study participants would prefer a vaginal delivery, in an otherwise uncomplicated pregnancy. Only 12.2% (n = 23) opted for an elective caesarean section. The main reasons stated for this decision were concerns about incontinence (87.5%) and pelvic floor trauma (79.2%). Amongst the study participants, 83.6% would like to be part of a risk stratification system presented in the questionnaire which, with the aid of specific parameters, is intended to allow early identification of a population with a high risk of developing pelvic floor disorders. There was also great interest in postpartum pelvic floor recovery (97.8%) and an associated optional pessary therapy (64.4%). The type of delivery already experienced (vaginal delivery vs. primary caesarean section) and parity also reveals to have a significant influence on the personal preferred mode of delivery as well. Conclusions Urogynaecologists prefer vaginal delivery for themselves. There is a great interest to participate in a risk stratification process in order to approach childbirth in an individualized and risk-adapted manner.

scholarly journals Perinatal determinants of D-dimer levels in a cross-sectional study of low risk pregnant women

2016 ◽  
Vol 9 (2) ◽  
pp. 78-82
Author(s):  
NM Murphy ◽  
AS Khashan ◽  
DI Broadhurst ◽  
O Gilligan ◽  
K O’Donoghue ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
D Dimer ◽  
In Pregnancy

Background To examine perinatal determinants of the antenatal levels of D-dimers. Methods Cross-sectional study of 760 low risk pregnant women recruited into five gestational groups. Variables examined in antenatal groups included maternal age, body mass index, parity, smoking, family history venous thromboembolism (VTE) and previous use of the oral contraceptive pill (OCP). Onset of labour and mode of delivery were also examined in the post-natal group. Results D-dimer levels in group 4 (38–40 + 6) were significantly lower in the women with a history of taking the OCP when compared to those that had not taken it in the past ( P = 0.027). In the day 2 post-natal group, the median level of D-dimer was significantly higher in primparous when compared to multiparous women ( P = 0.015). The median D-dimer levels were significantly lower in the elective Caesarean section group in comparison to spontaneous onset ( P = 0.003) and induction of labour ( P = 0.016). When the mode of delivery was examined, the median D-dimer levels were significantly lower in those that had an elective Caesarean section when compared to normal vaginal delivery ( P = 0.008) and instrumental vaginal delivery ( P = 0.007). Women post elective Caesarean section had a significantly lower D-dimer than those after emergency Caesarean section ( P = 0.008). Discussion There are some significant differences in D-dimer levels when certain perinatal determinants are examined. This work is potentially beneficial to the future diagnosis of VTE in pregnancy as it supports previously published recommended D-dimer levels for the diagnosis of VTE in pregnancy.

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