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Francesca Raffi, MBChB, MRCOG; Saad Amer, MBChB, MSc, MRCOG, MD, 01 Jun 2012

Endometriosis is a common gynaecological condition affecting about 6–10% of women of reproductive age and can be a debilitating disease. It is the second most common reason for surgery in premenopausal patients. It is defined as the presence of endometrial-like tissue outside the uterine cavity, leading to a chronic inflammatory reaction. The exact aetiology is unknown, but the retrograde menstruation model is the most widely accepted theory explaining the development of pelvic endometriosis. According to this model, menstrual blood containing endometrial fragments passes through the fallopian tubes into the pelvic cavity, resulting in the formation of peritoneal endometrial deposits. There are three distinctive pathological types of pelvic endometriosis: superficial peritoneal implants, ovarian endometriomas, and deep infiltrating nodular lesions. The extent of the disease is very variable and often does not correlate with the severity of symptoms. Although it can sometimes be asymptomatic (in about 20% of cases), endometriosis is frequently associated with severe pain and infertility. Several management options exist for endometriosis and the choice depends on several factors such as age, fertility, severity of the symptoms, and extent of the disease. This review presents three different cases of endometriosis with different complexities and presentations. The diagnosis and various medical and surgical treatment options available to the clinician will be discussed.

 

Breastfeeding relaxation improves infant growth and behaviour

Kavitha G.Shekar
31 May 2016

Breastfeeding relaxation may alter breast milk composition resulting in better infant growth and behaviour, say researchers at the 49th European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) 2016 in Athens, Greece.

Breastfeeding mothers attending antenatal clinics in Malaysia from March to December 2014 were recruited and randomized into intervention (n=33) or control groups (n=31). [ESPGHAN 2016, abstract N-O-013]

Home visits to access infant growth, maternal stress and anxiety at 2-3 months (HV1), 6-8 months (HV2), and 12-14 months (HV3) were conducted. The intervention group listened to a guided breastfeeding meditation audiotape daily for 2 weeks, after each home visit. Height, weight and head circumference of the infant were measured, and before and after breast milk samples were collected, at each home visit. After each home visit, the mothers were also asked to record infant behaviour in a validated 3-day diary.  

The researchers used perceived-stress-scale and beck-anxiety-inventory to measure infant outcomes including mean sleeping time, awake and happy, feeding and distress at 1-2 weeks post HV1 and HV2.

Infants in the intervention group had significantly longer sleep duration at HV2 (856±98 versus 774±94 minutes; p=0.017). Increased relaxation audiotape use by breastfeeding mothers was positively associated with increased infant sleep time (~80 minutes longer; p=0.008), longer duration of infant sleep at HV2 (p=0.035), infant weight (p<0.01), and BMI (p<0.01).

The researchers found that infant body mass index (BMI) at HV2 was positively associated with this increased sleep time (p=0.003) and negatively associated with time awake (p=0.025). Increased infant awake time was detrimental to weight gain from HV1 to HV3 (p=0.019), and BMI at HV3 (p=0.02).

“[The] altered behavioural pattern may have resulted in additional energy being available for growth, which is consistent with observed effects of the intervention on weight and BMI. Mothers who are less stressed may have favourably altered breast milk composition by either changing calorie/hormonal levels that might affect infant growth and behaviour,” said lead author Dr. Nurul Husna M Shukri from the UCL Institute of Child Health, Childhood Nutrition Research Centre, London, United Kingdom. This, she added, would be their area of future research. 

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Most Read Articles
14 Oct 2017
In pregnant women, adherence to recommended dietary intake of fat and fibre is associated with a more beneficial and richer gut microbiota which, in turn, decreases levels of the inflammation marker glycoprotein acetylation (GlycA), a study has shown.
16 Oct 2017
Elagolix is safe and effective for reducing heavy menstrual bleeding in females with fibroids, a new dose-ranging, multiple-cohort study has shown.
13 Oct 2017
Dr Joon Kiong Lee discusses pharmacotherapy for osteoporosis and the role of FLS in fracture prevention
Francesca Raffi, MBChB, MRCOG; Saad Amer, MBChB, MSc, MRCOG, MD, 01 Jun 2012

Endometriosis is a common gynaecological condition affecting about 6–10% of women of reproductive age and can be a debilitating disease. It is the second most common reason for surgery in premenopausal patients. It is defined as the presence of endometrial-like tissue outside the uterine cavity, leading to a chronic inflammatory reaction. The exact aetiology is unknown, but the retrograde menstruation model is the most widely accepted theory explaining the development of pelvic endometriosis. According to this model, menstrual blood containing endometrial fragments passes through the fallopian tubes into the pelvic cavity, resulting in the formation of peritoneal endometrial deposits. There are three distinctive pathological types of pelvic endometriosis: superficial peritoneal implants, ovarian endometriomas, and deep infiltrating nodular lesions. The extent of the disease is very variable and often does not correlate with the severity of symptoms. Although it can sometimes be asymptomatic (in about 20% of cases), endometriosis is frequently associated with severe pain and infertility. Several management options exist for endometriosis and the choice depends on several factors such as age, fertility, severity of the symptoms, and extent of the disease. This review presents three different cases of endometriosis with different complexities and presentations. The diagnosis and various medical and surgical treatment options available to the clinician will be discussed.