Case History for the Pediatric Eye Examination

The art of taking a patient's case history is essential for a solid understanding of pertinent details before proceeding with an examination. While establishing rapport with the patient, the clinician should ask questions about birth history, developmental history, educational and social history. Active listening skills and flexibility of the provider are useful tools for an effective start to the examination. This chapter reviews categories of questions needed for optimization of case history for the pediatric patient. This includes questions focused on specific age categories, including infants and toddlers, preschoolers, elementary-aged children, and adolescents. The chapter author provides clinical pearls for a more efficient and effective exam, including a section on assisting children with special needs.

Comprehensive analysis of early pregnancy loss based on cytogenetic findings from a tertiary referral center

Background Pregnancy loss is one of the most common complications during pregnancy. Clinical consultation based on etiology analysis are critical for reducing anxiety and distress. This study aimed to perform a comprehensive analysis for products of conception (POC) in miscarriage based on genetic etiology and clinical information. Methods A retrospective study was conducted according to cytogenetic findings of 1252 POC from spontaneous pregnancy loss over 11 years. The frequencies and profiles of chromosomal abnormalities were discussed according to the classification of women with different maternal ages, previous miscarriage history, normal live birth history, and different modes of conception. Results A total of 667 (53.2%) chromosomal abnormalities were observed, including 592 (47.3%) cases of numerical abnormalities, 38 (3.0%) cases of structural abnormalities, and 37 (3.0%) cases of mosaic aberrations. In women above 40 years of age, the rates of chromosomal abnormalities and viable autosomal trisomy were significantly higher than those in women with ≤ 29, 30–34, and 35–39 years of age (p < 0.05). The frequency of abnormal karyotype in women with normal live birth history was 61.1%, significantly higher than 52.5% in women without normal live birth history (p < 0.05). There was no significant differences among women without, with 1–2, and ≥ 3 previous miscarriages regarding the rate of abnormal karyotype (p > 0.05); viable autosomal trisomy was less common in women with ≥ 3 previous miscarriages than women with < 3 miscarriages. The frequency of chromosomal abnormalities was 49.0% and 55.0% in women with assisted conception and natural conception (p > 0.05), respectively; monosomy X was more frequently detected in women with natural conception than assisted conception. Conclusion The frequencies and profiles of chromosomal abnormalities in early miscarriages are strongly associated with clinical information including maternal age, previous miscarriage, live birth history, and mode of conception. Cytogenetic analysis of POC should be recommended to women with a first miscarriage and women with normal live birth history.

Comprehensive analysis of early pregnancy loss based on cytogenetic findings from a tertiary referral center

Background Pregnancy loss is one of the most common complications during pregnancy. Clinical consultation and comprehensive understanding of the etiology are critical for reducing anxiety, distress, and depression. This study aimed to perform a comprehensive analysis for products of conception (POC) in miscarriage based on genetic etiology and clinical information. Methods Retrospective observation was performed on cytogenetic findings of 1252 POC form spontaneous pregnancy loss over an 11-year period. The frequencies and profiles of chromosomal abnormalities were discussed according to the classification of women with different maternal age, previous miscarriage history, normal live birth history, and different mode of conception. Results A total of 667 (53.2%) chromosomal abnormalities were observed, including 597 (47.7%) cases of numerical abnormalities, 33 (2.6%) cases of unbalanced structural abnormalities, 32 (2.6%) cases of mosaicism, and 5 (0.4%) cases of balanced rearrangement. In group of women above 40 years of age, the detection rates of chromosomal abnormalities and viable autosomal trisomy were significantly higher than those in groups of ≤ 29, 30 ~ 34, 35 ~ 39 years of age (p < 0.05). The detection rate of abnormal karyotype in women with normal live birth history was 61.1%, significantly higher than 52.5% in women without normal live birth history (p < 0.05). There was no significant difference among women without, with 1–2, and ≥ 3 previous miscarriages in the rate of abnormal karyotype (p > 0.05), and viable autosomal trisomy was less common in women with ≥ 3 previous miscarriages. The frequency of chromosomal abnormalities was 49.0% and 41.0% in women with assisted conception and natural conception (p > 0.05), respectively, and monosomy X was more frequently detected in women with natural conception. Conclusion The frequencies and profiles of chromosomal abnormalities in early miscarriages are strongly associated with clinical information including the maternal age, previous miscarriage, live birth history, and mode of conception. Even in women with a first miscarriage, or with a history of normal live births, chromosomal analysis of POC should be recommended for etiological assessment.

Revisiting the placental clock: Early corticotrophin-releasing hormone rise in recurrent preterm birth

Objective To determine if maternal plasma CRH and preterm birth history were associated with recurrent preterm birth risk in a high-risk cohort. Study design Secondary analysis of pregnant women with a prior preterm birth ≤35 weeks receiving 17-alpha hydroxyprogesterone caproate for the prevention of recurrent spontaneous preterm birth. All women with a 24-week blood sample were included. Maternal plasma CRH level at 24- and 32-weeks’ gestation was measured using both enzyme-linked immunosorbent assay (ELISA) and extracted radioimmunoassay (RIA) technologies. The primary outcome was spontaneous preterm birth <37 weeks. The association of CRH, prior preterm birth history, and the two combined was assessed in relation to recurrent preterm birth risk. Results Recurrent preterm birth in this cohort of 169 women was 24.9%. Comparing women who subsequently delivered <37 versus ≥37 weeks, mean levels of CRH measured by RIA were significantly different at 24 weeks (111.1±87.5 vs. 66.1±45.4 pg/mL, P = .002) and 32 weeks (440.9±275.6 vs. 280.2±214.5 pg/mL, P = .003). The area under the receiver operating curve (AUC) at 24 and 32 weeks for (1) CRH level was 0.68 (95% CI 0.59–0.78) and 0.70 (95% CI 0.59–0.81), (2) prior preterm birth history was 0.75 (95% CI 0.67–0.83) and 0.78 (95% CI 0.69–0.87), and (3) combined was 0.81 (95% CI 0.73–0.88, P = .001) and 0.81 (95% CI 0.72–0.90, P = .01) respectively for delivery <37 weeks. CRH measured by ELISA failed to correlate with gestational age or other clinical parameters. Conclusion In women with a prior preterm birth, CRH levels were higher and had an earlier rise in women who experienced recurrent preterm birth. Second trimester CRH may be useful in identifying a sub-group of women with preterm birth due to early activation of the placenta-fetal adrenal axis. Assay methodology is a variable that contributes to difficulties in reproducibility of CRH levels in the obstetric literature.

Later life outcomes of women by adolescent birth history: analysis of the 2016 Uganda Demographic and Health Survey

ObjectivesTo describe the long-term socioeconomic and reproductive health outcomes of women in Uganda by adolescent birth history.DesignCross-sectional study.SettingUganda.ParticipantsWomen aged 40–49 years at the 2016 Uganda Demographic and Health Survey.Outcome measuresWe compared socioeconomic and reproductive outcomes among those with first birth <18 years versus not. Among those with a first birth <18 years, we compared those with and without repeat adolescent births (another birth <20 years). We used two-sample test for proportions, linear regression and Poisson regression.FindingsAmong the 2814 women aged 40–49 years analysed, 36.2% reported a first birth <18 years and 85.9% of these had a repeat adolescent birth. Compared with women with no birth <18 years, those with first birth <18 years were less likely to have completed primary education (16.3% vs 32.2%, p<0.001), more likely to be illiterate (55.0% vs 44.0%, p<0.001), to report challenges seeking healthcare (67.6% vs 61.8%, p=0.002) and had higher mean number of births by age 40 years (6.6 vs 5.3, p<0.001). Among women married at time of survey, those with birth <18 years had older husbands (p<0.001) who also had lower educational attainment (p<0.001). Educational attainment, household wealth score, total number of births and under-5 mortality among women with one adolescent birth were similar, and sometimes better, than among those with no birth <18 years.ConclusionsResults suggest lifelong adverse socioeconomic and reproductive outcomes among women with adolescent birth, primarily in the category with repeat adolescent birth. While our results might be birth-cohort specific, they underscore the need to support adolescent mothers to have the same possibilities to develop their potentials, by supporting school continuation and prevention of further unwanted pregnancies.

Illuminate the Hidden Pain in Our Hearts——Analysis of the Image of “Aunt” in Mo Yan’s Novel Frog

Frog is a long-form masterpiece created by Mo Yan with the great concentration that touches the most painful part of the Chinese soul. The novel consists of four long letters and a drama written by the playwright Tadpole to the Japanese writer Sugitani. It is about the life experience of an “aunt”, a Chinese rural obstetrician and gynecologist, with vivid and touching details showing the sixty years of undulating birth history in rural China.