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PubMed1996

[On the hypothesis of cesarean birth rate stabilization in southeastern, Brazil].

Births in S. Paulo State (Brazil) between 1987 and 1993 were studied to test the association between cesarean section rates and the social and economic development. The study used both Health Regions and hospitals as units of analysis. The cross-sectional study of secondary data adopted as variables: cesarean section rates in 1987, 1992 and 1993 by hospital and region; kind of provider; link of hospital with medical school; post-neonatal infant mortality rate; number of banks per inhabitant; and consumption potential of the regional central town per inhabitant. The C-section rates in the period studied were around 48% for the State; between 21.3 and 85.5% for the regions; between zero and 100% for the hospitals; as for kind of provider, the higher rates were found in private hospitals (56% in 1993). Medical school hospitals held stable rates throughout the period, around 39%. The multiple linear regression showed that banks per inhabitant and consumption potential by inhabitants explained 48% of the variation of the regional C-section rates. The stabilization of the State C-section rates is questioned, since the data shows a shift in the mode of hospital rates to higher values. A re-structure of the care delivered to births is imperative in S. Paulo State, since cesarean sections, besides being medical procedures, have become a consumer good, a symptom of the perverse logic that pervades the current organization of the health system.

Analysis of Variance↗
PubMed2005

Large social disparities in spontaneous preterm birth rates in transitional Russia.

OBJECTIVE: This study estimated the effect of maternal sociodemographic, obstetric and lifestyle factors on the risk of spontaneous preterm birth in a Russian town. METHODS: All women with singleton pregnancies registered at prenatal care centres in Severodvinsk in 1999 comprised the cohort for this study (n=1559). Analysis was based on spontaneous live singleton births at the maternity home (n=1103). Multivariable logistic regression was applied to quantify the effect of the studied factors on the risk of preterm birth. Differences in gestation duration were studied using multiple linear regression. RESULTS: In total, 5.6% of all spontaneous births were preterm. Increased risks of preterm delivery were found in women with lower levels of education and in students. Placental complications, stress and a history of fetal death in previous pregnancies were also associated with elevated risks for preterm delivery. Smoking, hypertension and multigravidity were associated with reduced length of pregnancy in metric form. CONCLUSION: In addition to medical risk factors, social factors are important determinants of preterm birth in transitional Russia. Large disparities in preterm birth rates may reflect the level of inequalities in transitional Russia. Social variations in pregnancy outcomes should be monitored.

Adolescent↗
PubMed1976

[Effect of social factors on the relations between working mother and premature birth rate].

Basing on the results of a study of 6780 women we found already at the beginning of the 1970 years in the GDR a premature birth rate for occupied women not more unfavourable than for house-wives; the total rate by then was 5,9%. The present paper deals with the influence of certain social factors--e. g. educational and social status, personal status, number of children within a family - on the frequency of premature births for occupied women and house-wives.

Adult↗
PubMed1992

The Green Bay cesarean section study. II. The physician factor as a determinant of cesarean birth rates for failed labor.

OBJECTIVE: Our study was designed to develop a profile of specific labor management characteristics generally used by physicians with low versus those with high rates of cesarean sections in the care of nonprogressive labor in nulliparous patients. STUDY DESIGN: A 4-year retrospective data set was used to analyze all patients with nonprogressive labor cared for by 11 board-certified obstetricians and gynecologists practicing full-time at two Green Bay hospitals. Variations in labor management are analyzed and tested for their effect on the rate of cesarean section for failure of labor to progress. RESULTS: Cesarean section in nulliparous women for nonprogressive labor varied from 4.3% of all deliveries in the low group to 12.3% in the high group. Through multivariate analysis we developed a profile of specific labor management characteristics used by physicians with low versus those with high rates of cesarean section. CONCLUSION: These techniques can be used to definitively identify management strategies that result in a decrease in cesarean rates for nonprogressive labor.

Anthropometry↗
PubMed2004

The effect of advancing paternal age on pregnancy and live birth rates in couples undergoing in vitro fertilization or gamete intrafallopian transfer.

OBJECTIVE: This study was undertaken to determine effects of male aging on sperm parameters, fertilization, pregnancy, and live birth rates among in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) couples. The impact of female age was also investigated. STUDY DESIGN: Prospective study was made up of 221 IVF and GIFT couples. RESULTS: Pregnancy rates declined as the male subjects aged. Each additional year of paternal age was associated with 11% increased odds (P=.007) of not achieving a pregnancy, and 12% odds (P=.01) of not having a successful live birth. For first-time IVF/GIFT recipients, each additional year of paternal age was associated with a 5% increased odds of not achieving a pregnancy, whereas for repeaters it was 40% (P=.01). Advancing maternal age was associated with decreased numbers of oocytes retrieved or fertilized. Women 40 years or older compared with younger than 35 years had greater than 4-fold risk of not becoming pregnant, and greater than 20-fold risk of not achieving a live birth. CONCLUSION: Advancing paternal (and maternal) age had a deleterious effect on IVF and GIFT outcomes.

Adult↗
PubMed1988

Epidermal tissue homeostasis. III. Effect of hydrocortisone on cell pool size, cell birth rate and cell loss in normal toads and in toads deprived of the pars distalis of the pituitary gland.

It has previously been shown that in toad epidermis the cell birth rate (Kb) exceeds the rate of cell loss through moulting (Kd) and that the 'surplus' of cells seems to be removed in a controlled manner. Assuming that the epidermis is non-expanding, a Kb/Kd ratio greater than 1 indicates that cell deletion additional to desquamation takes place. In normal toads this ratio is 2-3. Following implantation of hydrocortisone pellets into intact toads (release rate, 18 micrograms/g toad/d), the Kb/Kd ratio, over a period of 14 d of hormone treatment, had increased to about 7, due mainly to an increased Kb and to a lesser extent to a decreased Kd. No change in the epidermal cell pool size had taken place. It was previously shown that, following removal of the pars distalis of the pituitary gland, the Kb/Kd ratio decreased with time, due to a decreasing Kb and an increasing Kd, eventually leading to a decreased epidermal cell pool size. In this paper it is shown that, in pars distalisectomized toads with hydrocortisone pellets implanted, the Kb/Kd ratio is restored to control levels by a restoration of the Kb as well as the Kd. The results differ from those of previous studies in which ACTH or adrenocorticosteroids were administered discontinuously (by injection). Thus, by experimental manipulation, different Kb/Kd ratios can be obtained: low (less than 1, pars distalis ablation), medium (2-3, normal toads) and high (7, hydrocortisone implantation). The potentiality of this unique situation in analysing the important question of how the 'surplus' cells are deleted is discussed.

Animals↗