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PubMed1995

Association of post-cesarean delivery endometritis with colonization of the chorioamnion by Ureaplasma urealyticum.

OBJECTIVE: To determine if asymptomatic antenatal colonization of the chorioamnion with Ureaplasma urealyticum is a risk factor for the development of post-cesarean delivery endometritis. METHODS: The chorioamnion was cultured at cesarean delivery for aerobic and anaerobic bacteria, mycoplasmas, Chlamydia trachomatis, and Trichomonas vaginalis in 575 singleton gestations with intact membranes. Culture results were compared with the clinical outcome. Postoperative endometritis was defined as a temperature of 38C with uterine tenderness and without other nonpelvic sources of fever. RESULTS: Fifty-eight (10%) of the 575 women developed endometritis. Women with spontaneous labor developed endometritis twice as often as those delivered for medical or obstetric indications (17 versus 8%, P = .002). Endometritis occurred in 28% of women with U urealyticum present in the chorioamnion at cesarean delivery, compared with only 8.4% if the culture was negative and 8.8% if only bacteria other than U urealyticum were isolated (P < .001). Gestational age less than 34 weeks, spontaneous labor, and a vertical uterine incision were all associated with endometritis (P < or = .002). Regression analysis controlling for gestational age and incision type revealed a threefold increased risk of endometritis if the chorioamnion was colonized with U urealyticum at cesarean (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.1-8.3) and an eightfold risk (OR 7.7, 95% CI 1.9-31.5) in women in whom the onset of labor was spontaneous. CONCLUSION: Colonization of the chorioamnion with U urealyticum in women with intact membranes being delivered by cesarean is a significant, independent predictor of subsequent endometritis.

Amnion↗
PubMed1993

Prostitutes and chimney sweeps both have problems: towards full integration of both sexes in the study of occupational health.

Recently, natural and social scientists have pointed out that the need to make scientific results apply to both sexes is not met by simply adding women as research subjects. They suggest that the social and biological specificity of both sexes must be recognized and adjustments made to the ways questions are asked, hypotheses are generated, research subjects are chosen, and data are analysed. It is important to examine the definitions, concepts and methods used in research in occupational health to see whether they obstruct recognition of women's occupational health problems or interfere with gender-neutral standard setting. Unravelling the effects of sex on occupational health is complicated by the fact that women and men do not, by and large, work at the same jobs. Definitions of "work" must in some cases be adjusted to take account of women's occupations, just as definitions involving "health" must include women's biological specificity. Appropriate changes must be made to generate sex-inclusive definitions of exposures to occupational hazards and of health effects. Methods for evaluating exposures typical of women's work must be developed. Women and their work must be appropriately included when standards for occupational exposures are set. If these adjustments are not made, women's occupational health problems will be seriously underestimated and understanding of health problems of both sexes will be hindered. Sociological analysis should also be done to reveal the mechanisms by which biased concepts and procedures develop and are reinforced.

Adult↗
PubMed1997

Cervical prolapse complicating pregnancy.

Uterine cervical prolapse concurrent with pregnancy is rare. This article reports three cases of second-degree cervical prolapse during pregnancy. Two women developed prolapse in the late second trimester while one women had preexisting prolapse. Both women with prolapse developing during midpregnancy were treated unsuccessfully with a vaginal pessary to maintain cervical placement. Premature labor occurred in both of these women, resulting in one preterm birth. Although cervical prolapse is rarely encountered in pregnancy, the threat of preterm labor and delivery warrants close observation.

Adult↗
PubMed1992

Contribution of psychological and social factors to psychotic and non-psychotic relapse after childbirth in women with previous histories of affective disorder.

Twenty-six women with a history of bipolar or schizoaffective disorder, 17 women with histories of major depressive disorder and 45 control women without any previous psychiatric history were assessed in the 9th month of pregnancy on selected psychosocial measures. No subject was a 'case' as defined by the Research Diagnostic Criteria (RDC) from this time until the delivery. Within 6 months postpartum, 22 (51%) of the women with histories of mental illness were categorised as having relapsed (RDC case). Twelve women developed a psychosis (mania, hypomania or schizomania) and these illnesses occurred only in women with histories of affective or schizoaffective psychosis whereas 10 other women who became depressed after delivery came equally from the women with histories of psychosis (N = 5) as from those with histories of major depression (N = 5). Three (7%) control women also developed postpartum non-psychotic depressive disorders. Multivariate analyses suggest that different psychosocial factors contribute to the recurrence of affective and schizoaffective psychosis after delivery as opposed to non-psychotic postpartum affective disorders. A non-psychotic illness was predicted by antenatal neuroticism and a severe life event before illness onset. A recurrence of psychosis postpartum was predicted by a history of mania, hypomania or schizomania, a more recent psychiatric admission and reported marital difficulties. In this sample of women, life stress led to postpartum depression irrespective of the subject's past history and the high rates of recurrence of affective or schizoaffective psychosis (47%) probably mainly reflected a pre-existing physiological or psychological vulnerability which may have been exacerbated by, or contributed to, marital difficulties.

Bipolar Disorder↗
PubMed1991

Impaired intrathyroidal iodine organification and iodine-induced hypothyroidism in euthyroid women with a previous episode of postpartum thyroiditis.

Postpartum thyroiditis (PPT) is common and occurs in 1.7 to 16.7% of pregnant women, depending upon the study population. Most of these women develop transient hypothyroidism and thyroid function usually returns to normal. We have studied 11 euthyroid women with a previous history of PPT to determine the incidence of subtle defects in thyroid function measured by iodide-perchlorate (I-ClO4) discharge tests and TRH tests and to determine whether these women would develop iodide-induced hypothyroidism. Seven (64%) had positive I-ClO4 discharge tests and 5 (46%) had an abnormally high TSH response to TRH. Thyroid antimicrosomal and antithyroid peroxidase were positive in 8 women (73%) with a previous episode of PPT. The administration of pharmacological amounts of iodide (10 drops of saturated solution of potassium iodide daily) for 90 days to these 11 women resulted in elevated basal and TRH stimulated serum TSH concentrations in 8 (72.7%) compared to TSH values during iodide administration to women who had never been pregnant. Antimicrosomal and antithyroid peroxidase concentrations did not change during iodide administration. These findings strongly suggest that euthyroid women with a previous episode of PPT have permanent subtle defects in thyroid hormone synthesis and are inordinately prone to develop iodide-induced hypothyroidism, similar to findings previously reported in euthyroid subjects with Hashimoto's thyroiditis, with a previous episode of painful subacute thyroiditis, or previously treated with radioactive iodine or surgery for Graves' disease.

Adult↗
PubMed2003

Encouraging Vietnamese-American women to obtain Pap tests through lay health worker outreach and media education.

BACKGROUND: Five times more Vietnamese-American women develop cervical cancer than white women. Few studies have examined whether community-based participatory research can effectively address Asian immigrants' health problems. This article reports the preliminary evaluation of 1 such project. METHODS: A coalition of 11 organizations in Santa Clara County, California worked with university researchers to design and simultaneously implement a media education (ME) campaign and a lay health worker outreach (LHWO) program to increase Vietnamese-American women's cervical cancer awareness, knowledge, and screening. Two agencies each recruited 10 lay health workers (LHWs), who, in turn, each recruited 20 women who were then randomized into 2 groups: 10 to LHWO+ME (n = 200) and 10 to ME alone (n = 200). LHWs organized meetings with women to increase their knowledge and to motivate them to obtain Pap tests. Participants completed pre- and post-intervention questionnaires. RESULTS: At post-intervention, significantly more LHWO+ME women understood that human papillomavirus and smoking cause cervical cancer. The number of women who had obtained a Pap test increased significantly among women in both LHWO+ME and ME groups, but substantially more in the LHWO+ME group. Significantly more LHWO+ME women said they intended to have a Pap test. CONCLUSIONS: Media education campaigns can increase Vietnamese women's awareness of the importance of Pap tests, but lay health workers are more effective at encouraging women to actually obtain the tests. Lay health workers are effective because they use their cultural knowledge and social networks to create change. Researchers, community members, and community-based organizations can share expert knowledge and skills, and build one another's capacities.

Adult↗
PubMed1991

[Urinary infections during pregnancy and methods of prevention].

Urinary tract infections in pregnant women develop owing to the short urethra in women, mechanical pressure of the uterus onto atonic urethra during pregnancy, atony of the urinary bladder caused by the level of progesterone, iatrogenic factors (catheterization), some metabolic disorders, anemia, obstipation etc. These are frequent reasons why pregnant women over the pregnancy period develop infections of urinary tract, where a significant number of them have bacteriuria showing no symptoms of acute infection whatsoever. The research covered unselectively 4,850 urine samples of pregnant women. The results obtained by classical methods--taking urinoculture and doing antibiogramme--have shown that in this sample there is a large number of asymptomatic bacteria (13%), which is complicated by an increased incidence of pyelonephritis gestoses in the second half of the pregnancy. In our sample, the commonest cause of urinary infections has been E. Coli, then the second trimester of risk gestation period; the risk group with regard to parity are primiparas, while the risk age is between 20 and 29.

Adult↗
PubMed2001

High-risk HPVs and risk of cervical neoplasia: a nested case-control study.

The purpose of this nested case-control study was to estimate the risk of SIL development among a cohort of women providing cervical samples as part of their family planning visit at baseline in 1991-1992. All women had normal cervical cytology (N = 2905) at baseline and provided a cervical sample for subsequent HPV typing. Among this cohort, 426 women developed SIL (22 HSIL and 404 LSIL), 619 developed atypia, and 1860 remained cytologically normal. Two controls per case were sampled from those who remained normal. PCR-based methods with L1 consensus primers were used to assess high-risk HPV positivity. Having an oncogenic HPV type at baseline was associated with an almost fourfold increased risk of HSIL development (relative risk (RR) = 3.8; 95% CI, 1.5--9.0) and a 70% increased risk of LSIL development (RR = 1.7; 95% CI, 1.2--2.3%). The association between HPV positivity and SIL development was strongest in the first year of follow-up (RR = 9.2 for HSIL and 2.5 for LSIL development). The decline in HPV-associated SIL risk may be a function of having only one measure of HPV positivity (at baseline).

Adult↗
PubMed1988

Urodynamics following radical abdominal hysterectomy for cervical cancer.

We performed urologic evaluations and urodynamic studies on 40 patients before and 2 weeks, 6 months and 1 year after radical abdominal hysterectomy for cervical cancer. Preoperative findings were mostly within normal limits. Fourteen days after surgery, all patients had small, spastic bladders and 68% had residual urine. Bladder sensation was impaired in all patients at 2 weeks and in 63% after 1 year. The average bladder capacity was 400 ml before surgery, 180 ml at 2 weeks, 350 ml at 6 months, and 460 ml at 1 year. One year postoperatively, no patient had residual urine, but 17.5% had asymptomatic bacteriuria, 17.5% had bladder trabeculation, 62.5% had abnormal compliance, and 85% used abdominal straining to void. Three patients developed overflow incontinence and 8 women developed urodynamic stress incontinence. Most patients were tolerant of the observed dysfunction.

Female↗
PubMed2003

Racial and body image differences in coping for women diagnosed with breast cancer.

Although more White women develop breast cancer, African American women more frequently die of the disease (American Cancer Society, 2003). Despite higher morbidity among African American women, few studies have included racially diverse samples. The purposes of this study were to explore racial and body image differences in coping and self-efficacy in coping and racial differences in body image perceptions among breast cancer patients. The 92 participants ranged in age from 28 to 86 years (M=57.64, SD=12.48). Participants with higher body image perceptions had significantly higher self-efficacy in coping compared with participants with lower body image perceptions. There were no significant racial or ethnic differences in coping, self-efficacy in coping, or body image perceptions.

Adaptation, Psychological↗
PubMedDate not supplied

[Women and strokes: specific therapy for female patients].

INTRODUCTION: Stroke is the primary cause of mortality and incapacity of women in Spain. Current therapeutic guidelines are based on clinical trials in which the number of females taking part is insufficient, and overall benefits are then dangerously extrapolated to women. DEVELOPMENT AND CONCLUSIONS: Strokes in women have important features that distinguish them from those suffered by males, both as regards risk factors and aetiology, and in prevention and the therapeutic treatment that is performed during the fertile stage, pregnancy and menopause. There is, then, a need for further studies and specific clinical trials about strokes in females. Health professionals, society and the authorities, as well as women themselves, also need to be made more aware of the importance of strokes and to be provided with more information. If not, this epidemic will increase, especially if we bear in mind the foreseeable increase in life expectancy, and mortality and loss of independence in women will rise along with it.

Adolescent↗
PubMed1991

[The relationship between the sympathetic nerves and immunocytes in the spleen].

Ever since Galen, the ancient Greek physician, said "Melancholic women develop disease more than sanguine women," it has been said that the mental condition affects the physical condition. However, there is hardly any scientific verification. About half a century ago, Selye (1936) proposed a relationship between stress and immune function, and it is becoming increasingly clear that the nervous system and immune system interact with each other. Also researchers have strongly hoped to demonstrate the existence of specific pathways by which immunocytes can be directly regulated by the nervous elements instead of by the humoral influence of immunomodulators. In this study, the author showed by electron microscopic observation how the immunocytes in the guinea pig spleen are directly innervated. The sustentacular supporting element of the guinea pig spleen is the connective tissue system which includes the capsulo-trabecular, peri-vascular and reticular systems. The latter system is composed of the outer sheath of the reticular cell or its cellular processes which have abundant microfilaments and the inner minute connective tissue space in which lamina densa-like material, collagenous fibrils, elastic fibers and nervous elements are present. The sympathetic adrenergic nerves for the spleen enter the organ, and scatter around the arterial walls. All components of the connective tissue system are continuous with each other, and the nervous elements appearing in the reticular system are the elongated ones from other connective tissue systems, especially peri-vascular connective tissue. Thus, the adrenergic nerves are more abundant in the white pulp, into which the central artery penetrates, than in the red pulp which arterioles or capillaries pass through. The minute connective tissue space of the reticular system may be called the noradrenalin (NA) canal because catecholamine released from the naked adrenergic nerve terminals in this tissue diffuses and is stored in this enclosed space. The reticular system in the spleen divides the parenchyma into small non-endothelial vascular spaces owing to its meshwork, and free mobile immunocytes, such as T-cells, B-cells and macrophages, stagnate in these spaces. This stagnation of the mobile immunocytes and the presence of the adrenergic nerves in the NA canals provide the chance for the immunocytes and nerves to meet each other in the following fashion; the reticular cell sheaths show the exposed phenomena owing to the contraction of the microfilament-rich reticular cell processes, caused by noradrenalin in the NA canal, and the nervous elements in the NA canals can face the nonendothelial vascular spaces where mobile immunocytes pass freely.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2006

Female education and maternal mortality: a worldwide survey.

OBJECTIVE: In terms of social and political development, women's human rights have not evolved in many developing countries to the same extent as they have in the developed world. We examined the relationship between women's status and human development and maternal mortality. METHODS: Using polynomial regression analysis with a sample of 148 countries, we investigated the impact of gender-related predictors, including education, political activity, economic status, and health, and human development predictors, such as infant mortality and Human Development Index, using data from the United Nations Human Development Report 2003. RESULTS: The Human Development Index and Gender Development Index are powerful predictors of both maternal and infant mortality rates. Female literacy rate and combined enrolment in educational programs are moderate predictors of maternal mortality rates. CONCLUSION: Strategic investment to improve quality of life through female education will have the greatest impact on maternal mortality reduction.

Educational Status↗
PubMed2003

Development of proteinuria or elevated serum creatinine and mortality in HIV-infected women.

BACKGROUND: Data on the incidence and prognostic significance of renal dysfunction in HIV disease are limited. OBJECTIVE: To determine the incidence of proteinuria and elevated serum creatinine in HIV-positive and HIV-negative women and to determine whether these abnormalities are predictors of mortality or associated with causes of death listed on the death certificate in HIV-positive women. DESIGN: The incidence of proteinuria or elevated serum creatinine and mortality was assessed in a cohort of 885 HIV-positive women and 425 at-risk HIV-negative women. SETTING: Women from the general community or HIV care clinics in four urban locations in the United States. OUTCOME MEASURES: Creatinine of >or=1.4 mg/dL, proteinuria 2 or more, or both. Deaths confirmed by a death certificate (92%) or medical record/community report (8%). RESULTS: At baseline, 64 (7.2%) HIV-positive women and 10 (2.4%) HIV-negative women had proteinuria or elevated creatinine. An additional 128 (14%) HIV-positive women and 18 (4%) HIV-negative women developed these abnormalities over the next (mean) 21 months. Relative hazards of mortality were significantly increased (adjusted relative hazard = 2.5; 95% confidence interval: 1.9-3.3), and there were more renal causes recorded on death certificates (24/92 (26%) vs. 3/127 (2.7%), p<.0001) in HIV-infected women with, compared with those without these renal abnormalities. CONCLUSIONS: Proteinuria, elevated serum creatinine, or both frequently occurred in these HIV-infected women. These renal abnormalities in HIV-infected women are associated with an increased risk of death after controlling for other risk factors and with an increased likelihood of having renal causes listed on the death certificate. The recognition and management of proteinuria and elevated serum creatinine should be a priority for HIV-infected persons.

AIDS-Associated Nephropathy↗
PubMed1990

[Arterial hypertension and the kidney in pregnancy].

Hypertension complicates approximately 10 per cent of all pregnancies and accounts for 20% of all maternal deaths. Blood pressure normally decreases in the first trimester of pregnancy, secondary to a decrease in peripheral vascular resistance, reaches its lowest point in the second trimester and then gradually increases to or near pregravid levels at term. Normal pregnant women develop vascular resistance to the pressor effect of angiotensin II, which is precociously lost in women who develop gestational hypertension. Prostaglandins seem to be involved in the development of this vascular refractoriness. An acute and reversible lesion--defined "Glomerular endotheliosis"--has been described as the basic pathologic pattern of pre-eclamptic nephropathy, although gestational hypertension can be superimposed on undiagnosed essential hypertension or any of a variety of renal diseases. The primary goal when treating gestational hypertension is successful termination of the pregnancy with the least trauma to mother and fetus. Antihypertensive drugs could be administered to prolong pregnancy when this is considered desirable, although pharmacological therapy of gestational hypertension remains a subject for dispute, because of the lack of closely controlled studies. Hydralazine and methyldopa are drugs with a long history of use in gestational hypertension. Beta-blockers have been shown to be as effective as methyldopa. Clinical experience with nifedipine is limited, but controlled clinical trials, currently in progress, suggest its suitability.

Adolescent↗
PubMed2006

Recurrence of clinical chorioamnionitis in subsequent pregnancies.

OBJECTIVE: To establish the role of clinical chorioamnionitis as an independent risk factor for recurrence in a subsequent pregnancy. METHOD: This was a historical cohort study of pregnant women who had their first and second deliveries at our institution between January 1988 and May 2005. The index pregnancy was restricted to those who delivered vaginally. Data were collected from a continuously updated obstetric database and included demographic and labor characteristics and neonatal outcomes. Chorioamnionitis was diagnosed clinically. RESULTS: The study population consisted of 23,397 women. During the index pregnancy, 10% of women developed chorioamnionitis. This group was significantly different from the rest of the cohort in terms of age, ethnicity, length of labor, epidural analgesia, use of internal monitors, and incidence of prolonged rupture of membranes. In the second pregnancy, 6% of those women again developed chorioamnionitis compared with 2% of women who did not have chorioamnionitis in the first pregnancy (odds ratio 2.93, 95% confidence interval 2.40-3.57). After adjusting for the above confounders, the increased risk of recurrence persisted (odds ratio 1.85, 95% confidence interval 1.49-2.30). CONCLUSION: Women delivering vaginally who were diagnosed with chorioamnionitis during their first pregnancy are at increased risk for chorioamnionitis in a subsequent pregnancy. This supports the concept that there may be a predisposition to chorioamnionitis that should be further investigated. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2001

Salivary cortisol levels and anxiety are not increased in women destined to develop preeclampsia.

OBJECTIVE: To compare salivary cortisol levels and maternal anxiety (general and pregnancy-specific) in the early and late second trimester of pregnancy between women who developed preeclampsia (PE) and women who remained normotensive. DESIGN: Nested case-referent study. In a prospectively studied cohort of 250 pregnant women, nine women developed PE in late pregnancy. These nine patients were matched and compared with nine controls. Diurnal cortisol levels were obtained by collecting saliva samples at 17-18 and 27-28 weeks gestation. Salivary cortisol levels were determined by radioimmunoassay. Maternal anxiety was determined by Spielberger's State-Trait Anxiety Inventory (STAI) and a pregnancy-specific stress questionnaire. RESULTS: For both patients and controls, a similar pattern of salivary cortisol excretion was observed. Salivary cortisol levels and anxiety scores (general and pregnancy-specific) did not differ significantly between patients and controls. CONCLUSIONS: Our findings do not lend support to a role for maternal anxiety or second trimester increases in circulating stress hormones in the pathogenesis of PE.

Analysis of Variance↗