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Objective The aim of the study is to evaluate whether pathologic severity of placenta accreta spectrum (PAS) is correlated with the incidence of small for gestational age (SGA) and neonatal birthweight. Study Design This was a multicenter cohort study of viable, non-anomalous, singleton gestations delivered with histology-proven PAS. Data including maternal history, neonatal birthweight, and placental pathology were collected and deidentified. Pathology was defined as accreta, increta, or percreta. The primary outcome was rate of SGA defined by birth weight less than the 10th percentile. The secondary outcomes included incidence of large for gestational age (LGA) babies as defined by birth weight greater than the 90th percentile as well as incidence of SGA and LGA in preterm and term gestations. Statistical analysis was performed using Chi-square, Kruskal–Wallis, and log-binomial regression. Increta and percreta patients were each compared with accreta patients. Results Among the cohort of 1,008 women from seven United States centers, 865 subjects were included in the analysis. The relative risk (RR) of SGA for increta and percreta did not differ from accreta after adjusting for confounders (adjusted RR = 0.63, 95% confidence interval [CI]: 0.36–1.10 for increta and aRR = 0.72, 95% CI: 0.45–1.16 for percreta). The results were stratified by placenta previa status, which did not affect results. There was no difference in incidence of LGA (p = 1.0) by PAS pathologic severity. The incidence of SGA for all PAS patients was 9.2% for those delivered preterm and 18.7% for those delivered at term (p = 0.004). The incidence of LGA for all PAS patients was 12.6% for those delivered preterm and 13.2% for those delivered at term (p = 0.8203). Conclusion There was no difference in incidence of SGA or LGA when comparing accreta to increta or percreta patients regardless of previa status. Although we cannot suggest causation, our results suggest that PAS, regardless of pathologic severity, is not associated with pathologic fetal growth in the preterm period. Key Points

Cookstove improvement projects in India have emerged from the longstanding concerns about the nexus of cooking, fuelwood, gender and the environment. Such work, both academic and interventionist, focuses on rural women hauling headloads of firewood from the forests to their kitchens, where they burn it for daily cooking in a mud cookstove [ chulha]. We argue that this focus on village women’s cooking is too narrow if we are to understand and address problems caused by burning fuelwood in India, as cookstove campaigns attend to villages and not cities, domestic cooking and not commercial uses, and women and not men. Ethnographic research in Rajasthan and Odisha shows why we must expand our understanding of fuelwood use beyond villages, rural kitchens and women, and how cookstove interventions, often expressed as concern for women, require gender analysis.

Background: Severe gestational hypertriglyceridemia is a dangerous and life threatening illness. Management can be difficult due to the limited data on safety of medical therapy during pregnancy. We present a case of severe gestational hypertriglyceridemia. Case Presentation: A 29 year old woman, G4P2012 at 23w3d, with a past medical history of gestational diabetes, nontoxic thyroid nodule, and hypertriglyceridemia presented to the emergency room for abdominal pain and nausea. She has no known family history of lipid disorders. Her last pregnancy was complicated by acute pancreatitis due to hypertriglyceridemia. Between pregnancies, her triglyceride level was >900 mg/dL and gemfibrozil therapy was advised, however reported nonadherence. In current pregnancy and after counseling, she was prescribed omega-3 acid ethyl esters (Lovaza) 2 grams twice a day and referred to maternal fetal medicine. Triglyceride level on admission was 3640 mg/dL, and she admitted to poor adherence to Lovaza. Liver function tests were within normal limits. She was started on an insulin drip, as well omega-3 fatty acids 4g daily. However, the triglyceride level remained elevated despite 72 hours on the insulin drip and it was subsequently discontinued. Plasmapheresis was discussed but deferred given no evidence of pancreatitis. Gemfibrozil 600mg twice a day was added to the omega-3 fatty acids which were titrated up to 2g three times a day. On her day of discharge, her triglyceride level was 2200 mg/dL and abdominal pain had resolved. She was maintained on gemfibrozil and Omega-3 fatty acids, with plans to increase them by 1g per week to reach a goal of 10g per day with a goal triglyceride level Conclusion: We present a patient with severe gestational hypertriglyceridemia with a known history of pancreatitis. Due to the rarity of this condition, there is limited data on the safety of treatments for hypertriglyceridemia in pregnant women. This case demonstrates the use of gemfibrizol is appropriate when the hypertriglyceridemia threatens the health of the mother and baby. Further studies are needed to establish efficacy and safety of the use of these treatments in pregnant patients.

Summary An estimated 2.7 billion people cook meals on biomass-fueled brick, stone, and clay stoves. Scarcity of wood and negative impacts on health and environment have motivated efforts to design and distribute “improved” cook-stoves in developing countries. In India, adoption is limited despite massive promotion over many decades. Existing research suggests that many rural women in India do not want improved stoves, and those who do face obstacles to adoption. We step back from the many good case studies to examine the broader story of improved cook-stoves (ICs) in India. We do so by bringing together technical research of applied science and narrative critique of social science. Rather than assuming a priori that traditional stoves require replacement, we ask why Indian cook-stoves been a magnet for so much attention, why adoptions rates have remained low, and what lessons might be learned from a broad, multi-disciplinary perspective. Our approach is critical and reflexive, given our own involvement in IC efforts, and puts gender at the center. Our “big picture” review shows that the Indian chulha, for all its problems, is a remarkably successful technology which also satisfies several important household needs. Hence, targeting this device for obsolescence has profound implications that cannot be reduced to energy consumption or environmental hazards. Rural women do not prioritize ICs, but addressing their priorities requires either capital-intensive investment or challenging powerful institutions. In contrast, IC interventions are relatively cheap, decentralized, mechanical and seemingly apolitical, hence their popularity in development programs. Our review of chulha research leads us to reject both the optimism of development planners who frame such problems as technical and the antagonistic pessimism of their critics. Searching for a middle ground requires stepping back from the dogma of efforts to improve biomass cook-stoves.

For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care >48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. Clinical Trial Registration— URL: https://www.isrctn.com . Unique identifier: ISRCTN71416914.

When parents dedicate a child to the goddess Yellamma, they give the child (usually a girl, but sometimes a boy) in marriage to the goddess; the child becomes a devadasi, a jogati, a jogamma. Devad...

INTRODUCTION:Estimation of fetal birth weight is a critical data point that can affect the management of women in term labor. However, the superior method of estimating fetal birth weight (EFW) using Leopold's maneuvers versus ultrasound continues to be debated. This study aimed to compare the accur

Inter-collegiate Indian dance competitions emerged in the late 1990s in the United States and have since become wildly popular. Why dance? Why now? We explore these questions through Nachte Raho, a competition hosted by a University of Iowa student organization. Such events allow participants to publicly embody the contradictions they experience as minoritized children of immigrants on a predominantly White campus. Thus, dance enables community building among minoritized students and has entertainment value to non-Indians. Students distinguish Nachte Raho from unruly “community functions” organized by immigrant parents and aim instead to produce a professionalized show intended primarily for peers.

Postpartum depression (PPD) causes significant morbidity in postpartum women and their newborns. Universal screening is mandated in many states despite little information on optimal interval and frequency of screening.The objective of this study was to determine whether the early Edinburgh Postnatal Depression Scale (EPDS) score (done within 96h after delivery) is predictive of the late EPDS score (done at outpatient postpartum visit).This retrospective cohort study selected 256 women delivered at Cooper University Hospital in Camden, NJ in 2013. All patients who presented to the office during the postpartum period completed the EPDS questionnaire, in accordance to our usual practice. The delivery and outpatient records were reviewed for demographic data, EPDS scores and outcomes. Three groups of EPDS scoring were analyzed:10 (low risk for PPD), 10-13 (borderline risk for PPD), and ≥14 (high risk for PPD). Early and late EPDS scores were compared using Pearson Chi Square test. The relationship between scores was calculated using the Spearman Rho Correlation test. Assuming the EPDS groups would not change, a sample of 200 was needed with 80% power and 5% α-error.EPDS scores remained the same or improved in 92.2% (189/205) of women. The 16 women whose scores worsened were more likely to have had a diagnosis of prior psychiatric illness (50% vs 16.4%, p=0.003) and/or a diagnosis of fetal anomaly (12.5 vs 1.6%, p=0.05). An early EPDS score of10 had a 92.7% probability of maintaining low risk screening (EPDS10) at a later time.In low risk women, there is good correlation between early and late EPDS scores and so these women may not need to be rescreened. Therefore, we should redirect the limited available resources from screening low risk women multiple times, towards provision of follow-up care for the smaller number of women at highest risk. We propose that "women know your number" (EPDS prior to discharge); and providers re-screen only those women who score positive on PAP10, which stands for Psychiatry history, Anomaly, Preterm delivery, and EPDS score of 10 or more.

Video abstract Video, Preterm birth is a major health problem for the neonate, family, country, and society in general. Despite many risk factors being identified for women destined to deliver preterm, short cervical length detected on transvaginal ultrasound is the most plausible, practical and sensitive risk factor for prediction of spontaneous preterm birth. The definition of short cervix has varied in various studies, but most commonly accepted is ≤2.5 cm in the midtrimester of pregnancy, though risk of spontaneous preterm birth (sPTB) increases as the cervical length decreases. Vaginal progesterone, a naturally occurring steroid hormone, is the most bioavailable form of progesterone for uterine and cervical effects with the fewest side effects. Multiple prospective studies have consistently shown its benefits in decreasing sPTB rate in women with asymptomatic midtrimester short cervix. The safety for mother and fetus, and tolerability of vaginal progesterone, particularly the gel form, is also well established. Vaginal progesterone is a minimally invasive intervention that is not painful and is very safe, with reasonable cost where the benefits (even if argued to be small) clearly outweigh the risks. Thus there should be little hesitation for implementation of universal transvaginal cervical length screening and preventive vaginal progesterone treatment for women with short cervix.

INTRODUCTION:Two types of cell free DNA (cfDNA) platforms are available to screen for fetal chromosome abnormalities. The “limited” platform screens for a fixed number of chromosomal abnormalities while the “expanded” platform screens for abnormalities throughout the entire genome. We sought to comp

Background. The optimal treatment for management of esophageal achalasia in pregnancy is controversial. Little information exists about pregnancy outcome after successful myotomy. Case. Achalasia in pregnancy was diagnosed when a patient presented with pneumomediastinum from microrupture of the overdistended esophagus. An attempt at surgical correction failed due to the development of aspiration pneumonia with general anesthesia. Conservative medical therapy was undertaken, but fetal growth restriction developed. The patient underwent interval surgical correction, but subsequent pregnancy 6 months later was complicated by acute diaphragmatic hernia necessitating preterm delivery. Conclusion. Prior to surgery in pregnancy, emptying the dilated esophagus via nasoesophageal tube suctioning maybe warranted to avoid aspiration. Women, despite having undergone successful myotomy, should be counseled on the risks of pregnancy and to avoid pregnancy for at least 1 year thereafter.

Women with a sonographic short cervix in the mid-trimester are at increased risk for preterm delivery. This study was undertaken to determine the efficacy and safety of using micronized vaginal progesterone gel to reduce the risk of preterm birth and associated neonatal complications in women with a sonographic short cervix.This was a multicenter, randomized, double-blind, placebo-controlled trial that enrolled asymptomatic women with a singleton pregnancy and a sonographic short cervix (10-20 mm) at 19 + 0 to 23 + 6 weeks of gestation. Women were allocated randomly to receive vaginal progesterone gel or placebo daily starting from 20 to 23 + 6 weeks until 36 + 6 weeks, rupture of membranes or delivery, whichever occurred first. Randomization sequence was stratified by center and history of a previous preterm birth. The primary endpoint was preterm birth before 33 weeks of gestation. Analysis was by intention to treat.Of 465 women randomized, seven were lost to follow-up and 458 (vaginal progesterone gel, n=235; placebo, n=223) were included in the analysis. Women allocated to receive vaginal progesterone had a lower rate of preterm birth before 33 weeks than did those allocated to placebo (8.9% (n=21) vs 16.1% (n=36); relative risk (RR), 0.55; 95% CI, 0.33-0.92; P=0.02). The effect remained significant after adjustment for covariables (adjusted RR, 0.52; 95% CI, 0.31-0.91; P=0.02). Vaginal progesterone was also associated with a significant reduction in the rate of preterm birth before 28 weeks (5.1% vs 10.3%; RR, 0.50; 95% CI, 0.25-0.97; P=0.04) and 35 weeks (14.5% vs 23.3%; RR, 0.62; 95% CI, 0.42-0.92; P=0.02), respiratory distress syndrome (3.0% vs 7.6%; RR, 0.39; 95% CI, 0.17-0.92; P=0.03), any neonatal morbidity or mortality event (7.7% vs 13.5%; RR, 0.57; 95% CI, 0.33-0.99; P=0.04) and birth weight1500 g (6.4% (15/234) vs 13.6% (30/220); RR, 0.47; 95% CI, 0.26-0.85; P=0.01). There were no differences in the incidence of treatment-related adverse events between the groups.The administration of vaginal progesterone gel to women with a sonographic short cervix in the mid-trimester is associated with a 45% reduction in the rate of preterm birth before 33 weeks of gestation and with improved neonatal outcome.

This essay traces the recent development of field-based research on contemporary women’s renunciation and points to fruitful areas for further work. While women renouncers have probably existed in small numbers since the ancient period in South Asia, there is little concrete information about their lives. Given the importance of marriage in the region, a woman’s rejection of domestic life is likely to arouse opposition from family and society. Given the representation of women as a threat to celibate men, ascetic women cannot assume support from male peers either. Until recently, they have been invisible in both public life and scholarship. Since the 1980s, however, women renouncers and gurus have increased in both number and visibility in the region and worldwide, as has research on the topic. This essay outlines the broader context of renunciation in South Asian religious traditions and then focuses on Hindu asceticism. Starting in the 1980s research on women’s renunciation was published and began to disrupt conventional paradigms for understanding Hindu renunciation. Despite the increase in excellent work on the subject in the last two decades, this survey suggests that future research is needed to address the statistical reality of women’s renunciation, the role of caste and other inequalities, ascetic masculinities, and transnational processes.

Diabetes prevalence has increased dramatically, with 1.3 million new cases diagnosed annually. Women with gestational diabetes mellitus (GDM) are at increased risk for developing overt diabetes later in life. In addition, their offspring, exposed to the diabetic environment in utero, are also at increased risk for developing obesity, glucose intolerance, and type 2 diabetes later in life. Diabetes begets diabetes. The GDM diagnosis provides the medical community with an opportunity to intervene with strategies to prevent and/or delay the onset of diabetes and its associated long-term complications. This article reviews the roles of medical nutrition therapy, physical activity, and pharmacotherapy in preventing type 2 diabetes in women with a GDM history.

Objective Preterm birth is the leading cause of perinatal morbidity and mortality worldwide. Treatment of preterm labor with tocolysis has not been successful in improving infant outcome. The administration of progesterone and related compounds has been proposed as a strategy to prevent preterm birth. The objective of this trial was to determine whether prophylactic administration of vaginal progesterone reduces the risk of preterm birth in women with a history of spontaneous preterm birth. Methods This randomized, double-blind, placebo- controlled, multinational trial enrolled and randomized 659 pregnant women with a history of spontaneous preterm birth. Between 18 + 0 and 22 + 6 weeks of gestation, patients were assigned randomly to once-daily treatment with either progesterone vaginal gel or placebo until either delivery, 37 weeks' gestation or development of preterm rupture of membranes. The primary outcome was preterm birth at ≤ 32 weeks of gestation. The trial was analyzed using an intent-to-treat strategy. Results Baseline characteristics were similar in the two treatment groups. Progesterone did not decrease the frequency of preterm birth at ≤ 32 weeks. There was no difference between the groups with respect to the mean gestational age at delivery, infant morbidity or mortality or other maternal or neonatal outcome measures. Adverse events during the course of treatment were similar for the two groups. Conclusion Prophylactic treatment with vaginal progesterone did not reduce the frequency of recurrent preterm birth (≤ 32 weeks) in women with a history of spontaneous preterm birth. The effect of progesterone administration in patients at high risk for preterm delivery as determined by methods other than history alone (e.g. sonographic cervical length) requires further investigation. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

This essay examines the lives of non-Indians who live as monastics in Rishikesh, India. As transmigrants, they cross national borders and occupy transnational social fields. However, they neither maintain a home outside of India nor use the language of displacement to describe their experience. They speak instead of feeling “at home” in India and of finally finding their place, thus unsettling the emphasis on displacement in models of transmigrant identities. I explore how Foreign Swamis experience India as home and point to certain characteristics that make India eligible to become “home” to non-Indians: discursive constructions of spiritual India, low cost of living, institutional support for the monastic life, and the Hindu doctrine of transmigration of the soul. Foreign Swamis are unusual, even radical, transmigrants in that most move from rich to poor country, with ascetic rather than worldly aspirations, and after renouncing family, employment, and country. Yet their narratives may prompt us to ask ...

Objective This study was undertaken to determine whether syncytiotrophoblast microvillous membranes (STBMs) stimulate maternal neutrophils to produce superoxide radicals in women with preeclampsia. Study design Serum levels of tissue polypeptide antigen (TPA), which is a marker for STBM, were measured in 25 nulliparous women (10 with mild preeclampsia, 6 with severe preeclampsia, and 9 controls). Superoxide production by maternal neutrophils from cases and controls and by donor neutrophils cocultured with the STBMs from cases and controls was measured spectrophotometrically by reduction of ferricytochrome C. Results Maternal TPA levels were significantly greater among cases than controls (P = .005). Superoxide production by maternal neutrophils and donor neutrophils cultured with STBM from cases of preeclampsia was greater than controls (P values .006 and .019, respectively), and dose-response relationships were observed. Superoxide production by maternal leukocytes was correlated with superoxide induction by STBMs in culture (P = .007). Conclusion STBMs in maternal blood induce neutrophils to generate superoxide radicals that may cause endothelial dysfunction in women with preeclampsia.

Objective To assess the role of biophysical profile (BPP) during normal labor. The secondary goal was to assess the effect of oxytocics, regional anesthesia, and ruptured membranes on fetal behavior during labor. Methods The BPP (according to the Manning criteria) was performed prospectively in 100 normal, singleton pregnancies in active labor. To evaluate its role in the prediction of cesarean delivery and admission to the neonatal intensive care unit (NICU), statistical analysis included χ 2 and Fisher exact tests for frequency analyses and t tests for comparisons of continuous data. Results At the mean cervical dilatation of 5.2 ± 1.4 cm, 73 women had a BPP score of at least 8/10, 16 had 6/10, six had 4/10, and five had 2/10. The BPP was not influenced by use of oxytocics, prostaglandins, or epidural anesthesia. Fetal breathing (95% versus 71%; P = .002) and gross fetal movements (98% versus 84%; P = .04) decreased with rupture of amniotic membranes (Table 2) . A BPP score of 6/10 or less in labor was associated with a relative risk (RR) for cesarean delivery of 8.00 (95% confidence interval [CI] 2.4, 26.5). Cessation of any ultrasound component of BPP significantly increased the risk of cesarean delivery and admission to the (NICU) (RR = 29; 95% CI 2.73, 308.66). In the multivariable analysis, however, fetal movements and amniotic fluid volume were most important in predicting the need for cesarean delivery. Conclusion Fetal heart rate monitoring alone did not predict the need for cesarean delivery or neonatal outcome, whereas the BPP did. Biophysical profile could prove to be a clinically useful adjunctive tool in the assessment of fetal well-being in labor.

International audience; BACKGROUND: Thrombophilias are common disorders that increase the risk of pregnancy-associated venous thromboembolism and pregnancy loss and can also increase the risk of placenta-mediated pregnancy complications (severe pre-eclampsia, small-for-gestational-age infants, and placental abruption). We postulated that antepartum dalteparin would reduce these complications in pregnant women with thrombophilia. METHODS: In this open-label randomised trial undertaken in 36 tertiary care centres in five countries, we enrolled consenting pregnant women with thrombophilia at increased risk of venous thromboembolism or with previous placenta-mediated pregnancy complications. Eligible participants were randomly allocated in a 1:1 ratio to either antepartum prophylactic dose dalteparin (5000 international units once daily up to 20 weeks' gestation, and twice daily thereafter until at least 37 weeks' gestation) or to no antepartum dalteparin (control group). Randomisation was done by a web-based randomisation system, and was stratified by country and gestational age at randomisation day with a permuted block design (block sizes 4 and 8). At randomisation, site pharmacists (or delegates) received a randomisation number and treatment allocation (by fax and/or e-mail) from the central web randomisation system and then dispensed study drug to the local coordinator. Patients and study personnel were not masked to treatment assignment, but the outcome adjudicators were masked. The primary composite outcome was independently adjudicated severe or early-onset pre-eclampsia, small-for-gestational-age infant (birthweight

Dysmorphogenesis in diabetic mothers occurs more frequently than in the general population. This phenomenon is believed to be caused by the teratogenic effects of metabolic fuel mixtures with associated membrane injury and aberrations in the biochemical constituents. The present experiment was designed to determine: 1) if hyperglycemia-induced membrane injury is associated with intracellular and/or extracellular lipid disturbances; 2) if supplemental myo-inositol therapy prevents hyperglycemia-induced embryopathy; 3) if a correlation exists between dietary myo-inositol, serum and tissue levels of myo-inositol, and conceptus development; and 4) the cellular content of arachidonic acid following myo-inositol supplementation. Sixty-five female Sprague-Dawley rats were mated, and divided into three groups. One group was nondiabetic normal controls, and two groups had diabetes experimentally induced with streptozotocin. Of the diabetic groups, one received a normal diet, while the other received a myo-inositol-supplemented diet during the period of organogenesis. Blood samples were collected on days 0 and 12 of pregnancy. Embryos and yolk sacs were analyzed for myo-inositol and arachidonic acid levels, using mass spectrochromatography. Dietary myo-inositol supplementation of diabetic mothers resulted in a significant decrease in the incidence of neural tube defects when compared with diabetics not receiving supplements (9.5 vs. 20.4%; P < 0.05). This protective effect was incomplete, based on the incidence observed in the nondiabetic controls (9.5 vs. 3.8%; P < 0.05). The myo-inositol embryonic tissue levels in the diabetic group which had been fed a regular diet without supplementation were significantly lower than in the nondiabetic group. Dietary therapy successfully restored myo-inositol levels in the yolk sacs, as suggested by similar tissue levels in diabetics receiving myo-inositol supplementation and normal controls (18.7 ± 1.3 vs. 19.1 ± 2.0 ng/mg; P = ns). Dietary therapy, however, failed to restore myo-inositol levels in the embryos, suggesting hyperglycemia-induced faulty transport of nutrients from the yolk sac to the embryo. No correlation was noted between maternal blood levels of myo-inositol, with or without supplementation, and the clinical outcome. Tissue arachidonic acid levels were markedly reduced in the conceptuses of diabetic mothers with (0.4 ± 0.1 μg/mg) or without (0.25 ± 0.08 μg/mg) myo-inositol supplementation when compared to the nondiabetic controls (3.33 ± 0.24 μg/mg). These data demonstrate that diabetes-induced embryopathy is associated with a deficiency state in both myo-inositol and arachidonic acid. The myo-inositol deficiency is not demonstrated at the serum level, but rather at the tissue level, suggesting a paracrine action. Dietary supplementation of myo-inositol is associated with an increase in tissue myo-inositol levels and a decrease in malformations. This therapy holds promise for use as a dietary prophylaxis against diabetic embryopathy.

Sannyasa generally represents itself and is represented by scholars as either ungendered or unambiguously masculine. Indeed, advaitic philosophy expects renouncers to transcend the body and ignore all social distinctions, while Brahmanic orthodoxy reveals its misogynous tendencies by restricting renunciation to elite men. What both perspectives share is an assumption that women must give up their femininity in order to renounce. I argue that the female renouncers I interviewed in Haridwar neither presented themselves as men nor as transcendent, ungendered beings. Rather, they likened themselves to female householders, both in the everyday problems they face in their interactions with men and in the 'motherly' qualities that make renunciation easier for women. Furthermore, hagiographic evidence seems to suggest that male renouncers may also become mothers. Thus, in spite of advaitic and Brahmanic statements to the contrary, sannyasa is not only highly gendered, but is sometimes gendered feminine.

OBJECTIVE : Embryopathy in diabetic mothers occurs at a rate four to five times higher than that observed in the general population. The current investigation was undertaken to assess the use of dietary myo -inositol supplementation as a pharmacologic prophylaxis to obviate the teratogenic effects of hyperglycemia in an in vivo study. STUDY DESIGN : Seventy Sprague-Dawley rats were mated and after conception were randomly divided into five groups: one group was nondiabetic normal controls and four groups had diabetes experimentally induced with streptozotocin. Of the diabetic groups, one received the usual diet, whereas the others received, respectively, 0.08, 0.16, and 0.5 mg/day supplemental myo -inositol orally. RESULTS : With the myo -inositol supplementation (0.08 mg/day), the incidence of neural tube defects was significantly reduced from 20.4% to 9.5% ( p myo -inositol was 0.08 mg/day. Increasing the dose of myo -inositol beyond that level did not significantly reduce the rate of neural tube defects. However, the resorption rate was increased to 29.8%. CONCLUSION : These data demonstrate that myo -inositol supplementation reduces the incidence of diabetic embryopathy and may serve as a pharmacologic prophylaxis against diabetes-induced congenital malformations.(Am J Obstet Gynecol 1997;176:536-9.)

This is an account of my stay with a female renunciant. In spite of her contemplative lifestyle, I suggest that Anand Mata sought to teach me about the meaning of renunciation by instructing me to negotiate social interaction with the male head of her ashram (hermitage) in such a way as to balance contradictory goals. These include treating others with compassion while remaining detached and avoiding exploitation. This narrative describes the problems of gender among Hindu ascetics, illustrates the complex subject positions that define most ethnographic encounters, and ponders the nature of feminist ethnography.

Background About 4% of pregnant women have concomitant cardiac disease and a few of these do not respond to medical therapy and require surgical correction during pregnancy. We report a unique case describing fetal hemodynamics and uterine blood flow before, during, and after maternal cardiopulmonary bypass, and compare them to normal reference values in the second trimester. Case A woman with severe aortic regurgitation underwent aortic valve replacement at 19 weeks' gestation. A nonpulsatile cardiac pump was used for cardiopulmonary bypass, maintaining the mean arterial pressure at 77–90 mmHg, with a peak flow rate of 3.5–4.0 L/minute/m 2 and core temperature of 34–35C throughout surgery. Blood velocity waveforms were recorded by Doppler ultrasound at the level of maternal main uterine artery and fetal vessels. Pulsatility index (PI) values were calculated. Preoperatively, fetal hemodynamic characteristics were within normal limits. Preoperatively, uterine artery PI was 3.9 (normal 0.5–1.5 at 20 weeks). Intraoperatively, fetal bradycardia ensued after aortic clamping (120 to 75 beats per minute), with a rise in umbilical artery PI (1.7 to 7.1) and disappearance of diastolic flow. The middle cerebral artery PI decreased (2.0 to 0.92) and the PI increased in the descending aorta (2.22 to 3.55), inferior vena cava (2.7 to 9.3), and ductus venosus (0.6 to 1.7). During bypass, after aortic clamping, nonpulsatile uterine artery flow was noted. Postoperatively, the uterine artery PI improved, to 1.0. Two days later, hydrocephalus and hydrops were observed. Conclusion Despite high peak flow rates, normal mean arterial pressure, and normothermia, fetal outcome was dismal. Nonpulsatile cardiopulmonary bypass under normothermia may not be able to meet the demands of the fetoplacental circulation.

INTRODUCTION:Current ACOG technical bulletin #144, 2014 states “Women with monoamniotic twin gestations should undergo cesarean delivery to avoid an umbilical cord complication of the nonpresenting twin at the time of the initial twin's delivery.” To assess feasibility of vaginal delivery, we compar

Sex, Sexuality, and the Anthropologist. Fran Markowitz and Michael Ashkenazi. eds. Chicago: University of Illinois Press, 1999.230 pp.

Objective. This study examined whether rates of selected neonatal complications vary by mode of delivery and whether these rates are changing as a result of the increasing cesarean delivery rate.Method. Birth certificates in New Jersey from 1997 to 2005 were matched to hospital discharge records for mothers and newborns.Results. In New Jersey, the total cesarean section rate for 2005 was 35.3%, a relative increase of 46% since 1997 (from 24.2%). Rates of transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS), regardless of mode of delivery, increased between 1997 and 2005 from 3.3 to 3.9% and 2.1 to 2.4%, respectively. Newborn injuries declined sharply (from 4.1 to 2.6%), whereas intra-ventricular hemorrhage (IVH) rates remained stable. The rates of RDS, TTN and IVH were highest for cesarean delivery without trial of labor, while the rate of injuries was highest for instrumental vaginal delivery.Conclusion. Neonatal complication rates varied by mode of delivery and decreased with...

Objective To investigate the efficacy of vaginal progesterone to prevent early preterm birth in women with sonographic evidence of a short cervical length in the midtrimester. Methods This was a planned, but modified, secondary analysis of our multinational, multicenter, randomized, placebo-controlled trial, in which women were randomized between 18 + 0 and 22 + 6 weeks of gestation to receive daily treatment with 90 mg of vaginal progesterone gel or placebo. Cervical length was measured with transvaginal ultrasound at enrollment and at 28 weeks of gestation. Treatment continued until either delivery, 37 weeks of gestation or development of preterm rupture of membranes. Maternal and neonatal outcomes were evaluated for the subset of all randomized women with cervical length < 28 mm at enrollment. The primary outcome was preterm birth at ≤ 32 weeks. Results A cervical length < 28 mm was identified in 46 randomized women: 19 of 313 who received progesterone and 27 of 307 who received the placebo. Baseline characteristics of the two groups were similar. In women with a cervical length < 28 mm, the rate of preterm birth at ≤ 32 weeks was significantly lower for those receiving progesterone than it was for those receiving the placebo (0% vs. 29.6%, P = 0.014). With progesterone, there were fewer admissions into the neonatal intensive care unit (NICU; 15.8% vs. 51.9%, P = 0.016) and shorter NICU stays (1.1 vs. 16.5 days, P = 0.013). There was also a trend toward a decreased rate of neonatal respiratory distress syndrome (5.3% vs. 29.6%, P = 0.060). Conclusion Vaginal progesterone may reduce the rate of early preterm birth and improve neonatal outcome in women with a short sonographic cervical length. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.