Induction of labor with misoprostol in grand multiparous patients.
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OBJECTIVE: To determine the characteristics associated with pregnancy and multiple gestation after human menopausal gonadotropin intrauterine insemination (hMG-IUI). DESIGN: Prospective study of all patients undergoing hMG-IUI between January 1, 1984 and December 31, 1989. SETTING: University affiliated private clinic. PATIENTS: Four hundred twenty-four infertility patients undergoing 779 cycles of hMG-IUI. MAIN OUTCOME MEASURES: The relationship between estradiol (E2), number and size of follicles, age, and initial semen quality on pregnancy and multiple gestations in hMG-IUI cycles. RESULTS: The number of follicles greater than or equal to 12 mm was correlated with births and predicted all multiple births (r = 0.140, P less than 0.001). The corrected birth rate was 25.8% for age less than 35 and 14.0% for age greater than or equal to 35 when four or more follicles were greater than or equal to 12 mm. The uncorrected clinical pregnancy rate (PR) and birth rate were 12.8% and 10.5%, respectively. Decreased births were associated with tubal adhesions alone (P less than 0.03) or with endometriosis (P less than 0.002), more than four cycles of treatment (P = 0.01), initial sperm count less than 5 x 10(6) per mL (P less than 0.01), initial sperm motility less than 30% (P less than 0.002), and age greater than or equal to 35 (P less than 0.01). Estradiol was correlated with birth rate (r = 0.160, P less than 0.001), which increased from 3.6% when E2 was less than 500 pg/mL to 19.6% when E2 was greater than or equal to 2,500 pg/mL. CONCLUSIONS: The outcome of hMG-IUI is related to the number of follicles greater than or equal to 12 mm, to E2, and to age. Optimal PRs from hMG-IUI require mild ovarian hyperstimulation.
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A multigravida with gestational diabetes, mild pregnancy-induced hypertension and a previous curettage received four doses of misoprostol (100 microg) at three hourly intervals for induction of labor at term. Vaginal delivery of a live healthy baby occurred 1 h after the fourth dose. Hindwaters were bloodstained. Three hours later, she had excessive bleeding. Examination showed that the left lateral uterine wall had ruptured. She recovered after hysterectomy and blood transfusions.
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Pregnancy is known to influence the function of ligaments of the knee in both humans and rabbits. During pregnancy, ligament laxity increases. The mechanism by which these changes in ligament function occur is unknown. The present study was undertaken to assess changes in the pattern of gene expression for a number of molecules which could be involved in the alterations in tissue function. Using RNA isolated from pregnant and age-matched nonpregnant rabbits, levels of mRNA for matrix molecules, proteinases and inhibitors, cytokines and growth factors and inducible nitric oxide synthase were assessed by semi-quantitative RT-PCR. The results indicate that the pregnancy-induced changes in the pattern of gene expression is very complex and differences in the changes observed for the medial collateral ligament and the anterior cruciate ligament may also indicate that ligament-specific effects of pregnancy occur. mRNA levels of some molecules were significantly elevated or suppressed, while others were unchanged, indicating that the changes observed were specific rather than general. While the extent of the molecules assessed was designed to be representative rather than exhaustive, the results indicate that there is likely no simple cause and effect relationship between the observed mechanical alterations during pregnancy and alterations in gene expression in the affected ligaments.
An archaeological investigation of a medieval cemetery gave us the opportunity to investigate 49 Danish skeletons dating from 1000 to 1250 A.D. and to compare them with 298 contemporary Danes (aged 19-79 years) and assess the millennial trend in bone mineral density (BMD) in populations considered genetically closely related. BMD and bone mineral apparent density (BMAD) of the femoral neck were measured by dual-energy X-ray absorptiometry (DEXA) and transformed into z scores. BMD(zscore) was significantly lower in medieval women (-0.54 +/- 0.25, p = 0.04), whereas BMD(zscore) in medieval men was significantly higher (0.55 +/- 0.22, p = 0.02). In medieval women, BMD(zscore) tended to increase with age (r = 0.42, p = 0.07), whereas no change was seen in men (r = 0.19, not significant [n.s.]). Also, BMAD(zscore) was significantly elevated in medieval men (1.00 +/- 0.28, p < 0.01), but in medieval women no difference was found (-0.28 +/- 0.21, n.s.). However, the correlation between BMAD(zscore) and age was significant in the medieval women where it increased with advancing age (r = 0.49, p = 0.03). In conclusion, medieval women had lower BMD when compared with contemporary women, but this relationship was reversed in women who survived to older ages. In contrast, medieval men had significantly higher BMD as compared with contemporary men at all ages. The observed lower BMD in medieval women can be explained by the well-known selective mortality among the younger women. A high birth rate and prolonged periods of lactation are the main reasons for the observed increased mortality, and therefore can also very likely explain the associated low BMD. The increase in the incidence of osteoporosis in modern elderly women could possibly, or partially, be explained by the survival of women who would have died prematurely had they lived in earlier centuries.
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OBJECTIVES: Our objectives were to determine whether pregnancy intendedness changes as the pregnancy progresses and, if so, in what direction. METHODS: Intendedness questions similar to those used in the 1988 National Survey of Family Growth were administered in the second trimester of pregnancy (16-18 weeks) and again in the third trimester (30-32 weeks) to a population of 1223 low-income women who were medically at high risk. Information was also collected on characteristics identified in previous studies as being associated with intendedness. Changes in reported intendedness status were categorized as positive if the woman switched from unwanted to mistimed or intended or from mistimed to intended. Changes were categorized as negative if the woman switched from intended to mistimed or unwanted or from mistimed to unwanted. RESULTS: Among the 436 women who reported an intended pregnancy at midpregnancy, 79.1% still reported the pregnancy as intended in late pregnancy, while 15.9% moved to mistimed and 6.4% to unwanted. Of the 601 women who reported a mistimed pregnancy in midpregnancy, 80.9% still reported it as mistimed in late pregnancy, with 13.9% switching to intended and 5.2% switching to unwanted. Of the 186 women who reported an unwanted pregnancy at midpregnancy, 62.9% remained unwanted, 30.7% switched to mistimed, and 6.4% switched to intended. CONCLUSIONS: This study indicates that intendedness is not fixed during pregnancy. Between the first and the second administration of the intendedness questions, 275 (22.5%) of the women changed their responses and the larger percentage (12.5%) changed them in a positive direction. These findings have both policy and clinical implications.
OBJECTIVES: The significance of reproductive factors on breast cancer risk has so far been characterized in populations with 5-paras as the highest category of parity. We extended these studies to a nationwide cohort of women with at least five births (grand multiparas = GM) by assessing the significance of parity, age at first birth, and average birth interval to the risk of breast cancer. METHODS: The study cohort obtained from the Population Register of Finland comprised 86,978 GM-women; the incidence of cancer cases was obtained from the populated-based Finnish Cancer Registry. During a follow-up of about 2 million person-years, 1508 breast cancers were obtained. Standardized incidence ratios (SIRs) were calculated by dividing the number of observed cases by the number expected on the basis of national rates. RESULTS: In the GM cohort the incidence of breast cancer was low (SIR 0.55, 95% confidence interval 0.52-0.58). The relative risk decreased significantly from 5-paras (SIR 0.60, adjusted for the other study variables) to 8-paras (SIR 0.40). The increase in the age at first birth from less than 20 years to 30+ years nearly doubled the risk (SIR from 0.40 to 0.73). Parity was a significant risk determinant only in ductal cancer, while shortening the birth interval was protective only in lobular cancer. The incidence of advanced breast cancer among GM-women exceeded the population rate in premenopausal women and in women with first birth at the age of 30 years or more. CONCLUSIONS: Our study demonstrated that young age at first birth and increasing number of births were independent and powerful protective factors from the fifth child onwards, while birth interval was weak in this respect. The tumor morphology and the clinical advancement of malignancy modified the dependence of breast cancer risk on reproductive variables.
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