SKIN-TO-SKIN CONTACT AND BREASTFEEDING AT CHILDBIRTH: WOMEN’S DESIRES, EXPECTATIONS, AND EXPERIENCES

ABSTRACT Objective: To analyze women’s desires, expectations and experiences regarding skin-to-skin contact and breastfeeding in the first hour of life of their newborns. Methods: Qualitative research carried out in a teaching hospital in the Northeast Region of Brazil. The patients were followed longitudinally during prenatal care, at birth and during the puerperium. The participants were pregnant women during normal risk prenatal care, aged over 18 years old. Structured and semi-structured interviews were carried out in the prenatal period, participant observation at the time of delivery and new interviews in the puerperium. Content analysis was applied in the thematic modality. Results: 18 women between 21 and 38 years old were enrolled in the research. Women expressed the desire for skin-to-skin contact and breastfeeding as immediate practices right after delivery and birth. However, many women did not believe it was possible, and the performance of routine procedures was considered the main obstacle. These expectations that skin-to-skin contact and early breastfeeding would not be carried out were confirmed in the experiences immediately after birth. Conclusions: The expectations and experiences brought by these women suggest a flaw that starts in prenatal care and implies difficulties in implementing the studied practices. Thus, the empowerment and participation of women can become an important tool in the humanization of birth.

Topographic and anatomical features of muscular and vascular structures in lateral cervical region during prenatal period of human ontogenesis

Background. One of topical areas of morphological research is features of topographic a relationships of the vascular, nervous, muscular, fascial and cartilaginous structures of the neck in prenatal period of human ontogenesis, as data on their formation at different stages of development will improve diagnostic methods of visualization and surgical correction of congenital and acquired pathologies of head and neck. Objective. To find out the peculiarities of synthopia of vascular and muscular structures of the lateral cervical region in human prefetuses. Methods. 9 human prenatal specimens aged 9-12 weeks of prenatal development have been studied by using a set of morphological methods, according to existing bioethical norms. Results. During 9th week of development, bony and musclar boundaries of the lateral triangle of the neck, the carotid vagina, and the components of the vascular-nervous bundle of the neck have been determined. Within the carotid triangle, the external carotid artery is located superficially; it is crossed frontally by the cervical branch of facial nerve and the sublingual nerve. The superior thyroid artery departs from the external carotid artery at the level of the cartilaginous model of the large horns of hyoid bone and passes to the rudiment of thyroid gland. Retropharyngeal space is found at 9th week of development, moderately filled with adipose tissue. The anterior vertebral plate of the cervical fascia forms the bottom for posterior triangle of neck. Conclusion. The lateral cervical region in human prefetuses is represented by a multilayered topographic zone with formed boundaries and contents. Cervical fascia forms carotid vagina within the carotid triangle, and pharyngeal space. The course of blood vessels and nerves within the lateral cervical region is variable. Three-dimensional reconstructions of prefetuses serve as evidence of the early formation of definitive topographic connections within early bony and cartilaginous models in relation to the muscles of the anterior and lateral cervical regions.

The Largest Germline Heterozygous Deletion Encompassing Potocki–Shaffer and WAGR Syndromes Loci to Date: A Case Report

Potocki–Schaffer syndrome includes multiple exostoses, parietal foramina, and variable developmental delay/intellectual disability. It is associated with a heterozygous deletion of the 11p12p11.2 region. In some cases, the deletion extends to the WAGR locus (11p13p12). We describe here a 9-month-old girl harboring the largest germline heterozygous deletion characterized so far. Oligohydramnios and parietal foramina were noticed during pregnancy. No patient has been diagnosed before with concomitance of these two syndromes during the prenatal period. Cytogenetic diagnosis was anticipated on basis of clinical and radiological signs. Postnatal conventional karyotype confirmed an interstitial 11p deletion: 46,XX,del(11)(p11.2p15.1). Array-comparative genomic hybridization characterized a 29.6 Mb deletion. Our case illustrates the interest of high-resolution genomic approaches to correlate adequately clinical phenotypes with specific genes in suspected contiguous gene deletion syndromes.

Hypoplastic Left Heart Syndrome: Diagnostic Difficulties in Prenatal Period

The article discusses the possible diagnostic errors in the hypoplastic left heart syndrome (HLHS) with mitral atresia and intact interventricular septum. “Atrioventricular canal defects” can be commonly and mistakenly diagnosed the prenatal period in such cases. The aspects and possibilities of differential diagnosis of these defects in the prenatal period are discussed. Ultrasound sign is presented in the article, we have named it “hockey stick with puck” that characterizes the retrograde blood flow in the aortic arch. This sign is diagnosed by color Doppler mapping of the sagittal section of the ductus arteriosus and can serve as a marker of mitral/aortic atresia.

Evaluation of the effectiveness of early intervention methods in newborns who have suffered hypoxic-ischemic CNS damage

Timely diagnosis of cerebral disorders both in the prenatal period and in the early neonatal period, as well as early rehabilitation treatment is the basis for the prevention of childhood disability. To this end, the so-called Early Intervention System is being introduced in Ukraine. The effectiveness of early intervention techniques directly depends on timely diagnosis and correctly chosen intervention tactics. Given the high neuroplasticity of the developing brain, it is advisable to start the elements of neurodevelopmental therapy from infancy. The aim of the work is to evaluate the effectiveness of methods of early intervention in children of the first 3 months of life who have suffered hypoxic-ischemic CNS damage in the neonatal period, by assessing the main indicators of psycho-motor development. 101 children who were treated in the neonatal pathology department due to hypoxic-ischemic CNS damage and did not have concomitant somatic pathology were examined. The children were in the ward for rehabilitation. To assess the effectiveness of comprehensive rehabilitation in young children, it is advisable to use adapted for Ukraine scale of Munich functional developmental diagnostics, which allows to assess the child's development in all major areas, its harmony and effectiveness of rehabilitation measures during the first 3 years of life. Statistical processing of the obtained results should be performed in the license package "Statistica 6.1 for Windows". Timely diagnosis of cerebral disorders both in the prenatal period and in the early neonatal period, as well as early rehabilitation treatment is the basis for the prevention of childhood disability. Given the high neuroplasticity of the developing brain, it is advisable to start the elements of neurodevelopmental therapy from infancy. The effectiveness of the methods recommended for use depends on timely diagnosis and correctly chosen intervention tactics. Assessment of the effectiveness of care for children at risk of deviant psychomotor development should be based on the application of the criteria and scales recommended by international expert groups, which are adapted in our country. Signs of full-fledged early intervention in the region are: perinatal diagnosis of congenital pathology, timely provision of medical and rehabilitation, social and special pedagogical services to children aged 0 to 3 years and their families. In order to achieve the set goals, in our opinion, the priority measures should be steps to implement the national protocol for care for children with perinatal CNS injuries, approval and implementation in Ukraine of the modern International Classification of Functioning, Life and Health Restrictions, providing medical care, rehabilitation and social services for young children.

Anatomical variations of sulci in human fetal cerebrum and its clinical significance

Introduction and Aim: Appearance of sulci and its number in the fetal cerebrum is a signal of growth and development. Chronological appearance and symmetrical development of sulci corresponds to gestational age of fetus. Few sulci can be visualized in the prenatal period to judge the growth of fetus. Any change in chronological appearance, symmetry and number of sulci in fetal cerebrum is of prime importance. Materials and Methods: Hundred and six cerebral hemispheres of 53 fetal brains of different gestational ages were collected from MGM Hospital Kalamboli and Aurangabad after institutional ethical approval to study the pattern of sulci on both sides after fixing in 10% formalin. Results: In 6 (5.6 %) cerebral hemispheres variation in appearance of sulci was observed. It was noted that there is change in number of superior temporal sulcus (STS), superior frontal sulcus (SFS), parieto-occipital sulcus (POS), calcarine sulcus (CS) and occipitotemporal sulcus (OTS) on both the sides in 6 cerebral hemispheres. Remaining 100 cerebral hemisphere showed normal, symmetrical appearance and number of sulci. Conclusion: It was observed that the fetal cerebral hemispheres which showed variations in appearance and number of sulci were associated with mother having eclampsia.