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The majority of the reviews and studies on chronic pain in pregnancy have primarily focused on the pharmacological and non-pharmacological treatment options. The purpose of our review was to identify evidence-based clinical research for the evaluation and management of preexisting chronic pain in pregnancy, chronic pain associated with pregnancy, and chronic pain in relation to mode of delivery. A literature search was undertaken using the search engines PubMed, CINAHL, EBSCOhost, and Web of Science. Search terms used included \"chronic pain\" AND \"pregnant OR pregnancy\" OR \"pregnancy complications\" from inception through August 2016. The basis of this review was the 144 articles that met inclusion criteria for this review. Based on our review of the current literature, we recommend 7 guidelines for chronic pain management during and after pregnancy: 1) complete history and physical examination; 2) monitor patients for alcohol, nicotine, and substance use; 3) collaborate with patient to set treatment goals; 4) develop a management plan; 5) for opioids, use lowest effective dose; 6) formulate a pain management plan for labor and delivery; and 7) discuss reproductive health with women with chronic pain. The management of chronic pain associated with pregnancy is understudied. Obstetrical providers primarily manage chronic pain during pregnancy. Some general guidelines are provided for those health care providers until more information is available.

This review examines the initial development of a transport system for neonates, followed by a subsequent evolution of a transportation system for the maternal/fetal unit, and then a maternal transport system (antepartum, intrapartum, and postpartum) to specifically address maternal morbidity/mortality. A literature search was undertaken using the electronic databases PubMed, Embase, and CINAHL. The search terms used were \"maternal transport\" AND \"perinatal care\" OR \"labor\" \"obstetrics\" OR \"delivery\". The years searched were 1960-2023. There were 260 abstracts identified and 52 of those are the basis of this review. The utilization of a transportation system with the regionalization of levels of care has resulted in a significant reduction in neonatal, perinatal, and maternal morbidity and mortality. Although preterm delivery remains a concern in women transported, the number of deliveries that have occurred during transport is relatively small. Reimbursement for transportation continues to be a problem in several states. A state-of-the-art transportation system has evolved that transfers neonates, maternal/fetal dyad, and pregnant women (antepartum, intrapartum, postpartum) to the appropriate level of care facility to ensure the best maternal/fetal/neonatal outcomes.

Objective: The purpose of this review is to examine the evidence that defines normal and abnormal amniotic fluid volumes (AFVs) and current recommendations on the management of abnormalities of AFV. Methods: The studies establishing normal actual AFVs and the ultrasound estimates used to identify normal and abnormal AFVs were evaluated. Recommendations from national and international organizations were reviewed for guidance on the definitions and management of abnormal AFVs. Results: A timeline of the development of the thresholds that define abnormal AFVs was created. Recommendations from 13 national and international guidelines were identified, but the definitions and management recommendations for abnormal AFVs varied considerably between groups. An algorithm for the management of oligohydramnios and polyhydramnios was developed. Knowledge gaps and the structure of future studies were examined. Conclusions: Assessment of AFV is performed multiple times per day in antenatal clinics and hospitals. Current recommendations on defining and managing abnormal AFVs differ between national and international organizations. We have proposed algorithms to assist in the management of abnormal AFVs until further studies can be undertaken.

Two different techniques are described in the literature for measuring amniotic fluid pockets to estimate amniotic fluid volume. This study was undertaken to determine if ultrasound estimates using amniotic fluid index (AFI) and single deepest pocket (SDP) techniques should be measured perpendicular to floor vs perpendicular to uterine contour in pregnancies between 20 and 28 weeks. Amniotic fluid was measured using AFI and SDP techniques in low risk pregnant women undergoing an indicated ultrasound between 20 and 28 weeks of gestation. Measurements of both AFI and SDP were made holding the ultrasound transducer perpendicular to the floor and then perpendicular to the uterine contour. Pearson's correlation coefficient was used to assess the association between estimated amniotic fluid volumes determined by the transducer perpendicular to the floor versus transducer perpendicular to the uterine contour; intra-class correlation coefficient was used to test agreement of the two techniques. Measurements were collected on 160 women between 20 and 28 weeks. For pregnancies between 20 and 28 weeks, the level of correlation for AFI was 0.67 (95% CI 0.57-0.74) [moderate] and for SDP was 0.47 (95% CI: 0.34-0.58) [poor]. In pregnancies between 20 and 28 weeks, the correlation of AFI values perpendicular to floor and perpendicular to the uterine contour remains moderate, either measurement can be used to estimate amniotic fluid volume. The correlation for SDP is poor and it remains uncertain which technique, perpendicular to floor or perpendicular to uterine contour, should be used for estimating amniotic fluid volume.

To maintain genomic integrity, all cells must accurately duplicate their genetic material in order to provide intact and complete copies to each daughter cell following cell division. Successful inheritance of chromosomal information without changing even a single nucleotide requires accurate and robust DNA replication. This requires that cells tightly control replication initiation from the origin(s), processive elongation of the replisome, and the completion of DNA replication by resolving convergent replication forks ensuring that each sequence is duplicated without alteration. Unlike initiation and elongation, the process by which replication forks converge and are resolved into two discrete, inheritable DNA molecules is not well understood. This process must be remarkably efficient, occurring thousands of times per cell division in human cells, and is likely to be a fundamental step in regulating genome stability in all cells. In this dissertation I address how DNA replication completes in the model system Escherichia coli. To achieve this, I examined candidate mutants for impairments in the completion of DNA replication. By evaluating growth, viability, chromosomal copy number, and plasmid stability I identified a requirement for the proteins RecBCD, ExoI, and SbcCD in the completion reaction. SbcCD and ExoI act before RecBCD in the completion reaction and process the DNA intermediates arising as replication forks converge. These enzymes act in the completion reaction without recombination or RecA, but in the absence of the normal process recombination is required to complete DNA replication via an aberrant pathway that results in genomic instability.

Environmental constraints influencing vegetation composition on the Shoshone National Forest, Wyoming, were determined using clique analysis. 939 plots and 32 environmental factors were divided into two perspectives. Clique analysis examines the relationship between vegetation composition and environment by generating sets of plots, called cliques, where each plot has a minimum level of vegetational similarity to every other plot in the clique. The method determines the maximum environmental difference among plots of each clique and calculates the probability of obtaining as small a range of environmental difference in sets of the same size chosen at random. Environmental constraints varied between the two perspectives. A hierarchy of environmental factors was determined, along with the degree of importance within each perspective. Vegetation pattern and composition are influenced by moisture availability driven by the effects of topography. Complex environmental gradients such as elevation and climate were dominate constraints influencing vegetation composition within both perspectives.