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PubMed2003

[Live birth distribution by time and place from 1981 to 1998 in Japan].

OBJECTIVES: To investigate the diurnal rhythm of live births labored spontaneously, and the effects of obstetric intervention on birth time distributions. METHODS: The data of live births tabulated by time (one-hour intervals), date and birthplace throughout Japan between 1981 and 1998 were obtained with permission from the former Ministry of Health and Welfare. Together with an investigation of hourly birth numbers by place in each year, an annual transition of hourly birth rates in medical institutions and the diurnal rhythm of birth numbers in maternity homes and at home were analyzed using regression analysis. RESULTS: In every calendar year studied the hourly live birth numbers at hospitals showed a single-peak distribution pattern with maximum values at 13:00-15:00. The annual transition of hourly birth rates showed a 10% (birth numbers base) decrease in the 11:00-13:00 period in 1998 as compared with that in 1981, while there was a corresponding increase of 8% in the 13:00-15:00 period. Hourly birth numbers at clinics showed a double-peak distribution pattern with maximum values during the 11:00-12:00 and 14:00-15:00 periods in early 1980, while a single-peak distribution with a maximum value during the 13:00-15:00 period appeared in 1989 and has remained thereafter. Hourly birth rates (birth numbers base) increased by over 6% in the 13:00-15:00 and 17:00-20:00 periods over the past 18 years, while they decreased by 10% in the 9:00-13:00 period. The results at maternity homes were clearly different from those at hospitals and clinics. The live birth numbers totaled for the 18 years showed a double-phase distribution with a maximum value in the 6:00-7:00 period and a minimum value in the 19:00-20:00 period. The best-fit regression model for the obtained data was a sine curve with a maximum value at 6:00 (coefficient of determination 0.97). Hourly distributions of live births at home also fitted best to a since curve with the maximum value again at 6:00 (coefficient of determination 0.95). CONCLUSIONS: The results suggested that the timing of spontaneous live births follows a circadian rhythm and that obstetric intervention affects time distributions of live births by shifting over 10% of births during the night and early morning to a working day service time (9:00-17:00).

Birth Rate↗
PubMed1996

The effects of prenatal diagnosis, population ageing, and changing fertility rates on the live birth prevalence of Down syndrome in New York State, 1983-1992.

The incidence of Down syndrome (DS) at conception is highly dependent on the maternal age distribution and age-specific pregnancy rates. The live birth prevalence of DS reflects these factors and fetal deaths. This study examined DS live birth prevalence from 1983 to 1992 in New York State and analysed the effects of demographic changes and prenatal diagnosis use on the observed live birth prevalence. Expected DS live birth prevalence without prenatal diagnosis was calculated and compared with observed. Data were obtained from birth defects registries, vital records, and population data maintained by the New York State Department of Health. Over time, DS live birth prevalence was stable at about 10.4 per 10,000 live births. The percentage and number of women in the population above age 30 increased, as did birth rates among these women. Birth rates among younger women decreased. The proportion of DS babies born to women aged 35 and over increased from 27.1 to 34.1 per cent. Use of prenatal diagnosis by this age group ranged from 39.6 to 43.2 per cent, and increased steadily from 1.8 to 4.3 per cent among women under 35. Detection of DS fetuses increased from 82 in 1985 to 233 in 1992. Without prenatal diagnosis, DS live birth prevalence in 1992 would have reached 15.3 per 10,000 live births compared to the 10.2 observed. Prenatal diagnosis has prevented an increase in DS live birth prevalence but has not been sufficient to reduce live birth prevalence significantly.

Adolescent↗
PubMed2002

Cumulative probability of live birth after three in vitro fertilization/intracytoplasmic sperm injection cycles.

OBJECTIVE: To assess the probability of live birth after three available in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. DESIGN: Retrospective, observational study. SETTING: University hospital. PATIENT(S): Nine hundred seventy-four couples who started their first conventional IVF or ICSI cycle between January 1996 and December 1997. A total of 1985 stimulated cycles were initiated. INTERVENTION(S): Analysis of the cumulative live birth rate using the life-table approach with and without taking dropouts into account. MAIN OUTCOME MEASURE(S): Cumulative live birth rate. RESULT(S): The overall cumulative live birth rate after three completed stimulated cycles (including freezing/thawing cycles) was 65.5% with an "optimistic" approach. For the "realistic" and "pessimistic" approaches the corresponding figures were 63.1% and 55.5%, respectively. Unexpectedly, 65% of couples not achieving a live birth interrupted the full treatment program of three cycles. CONCLUSION(S): The cumulative live birth rate gives the couple a more accurate prognosis of achieving a live birth after IVF/ICSI than the statistics usually provided. With the "realistic" estimation, 63% of the couples achieved childbirth after three available conventional IVF or ICSI cycles. Further studies are required to investigate the high drop-out rate.

Adult↗
PubMed1995

The prognosis for live birth among untreated infertile couples.

OBJECTIVE: To estimate the likelihood of live birth and the impact of prognostic factors among untreated infertile couples. DESIGN: Cohort follow-up study. SETTING: Eleven infertility clinics in academic medical centers. PATIENTS: Two thousand one hundred ninety-eight couples with infertility of > 1 year in duration. Untreated months of observations on 873 untreated couples (18,364 months) were combined with observations before the first treatment among 1,325 treated couples (9,761 months). INTERVENTIONS: Diagnostic tests as indicated. MAIN OUTCOME MEASURES: Time to conception for live birth; effect of baseline characteristics estimated by means of proportional hazards analysis. RESULTS: There were 263 live birth conceptions during 28,125 months of untreated observations. The cumulative rate of conceptions leading to live birth was 14.3% at 12 months. The relevant prognostic factors were pregnancy history, duration of infertility, female partner's age, male defect, endometriosis, and tubal disease. A prediction score based on these factors would be accurate in approximately 62% of cases. CONCLUSIONS: The estimation of live birth among untreated infertile couples is sufficiently accurate to be useful in the clinical management of infertility and in the planning of clinical trials.

Adult↗
PubMed2005

Risk of a Down syndrome live birth in women 45 years of age and older.

OBJECTIVES: To determine the risk of a Down syndrome (DS) live birth for women 45 years of age and over. METHODS: A meta-analysis of data from five published articles, 13 EUROCAT congenital anomaly population registers and two unpublished sources. RESULTS: Information was available on the number of DS live births occurring amongst 13,745 live births to women 45 years of age and over. Information was also available on DS pregnancies diagnosed prenatally that were subsequently terminated. These pregnancies were adjusted for expected fetal loss to estimate the number of live births that would have occurred in the absence of prenatal diagnoses, when a total of 471 DS live births were estimated to have occurred. The risk of a DS birth did not increase for women 45 years of age and over. The average risk was 34 per 1000 births (95% CI: 31-37). CONCLUSION: The risk of a DS live birth for women 45 years of age and over is considerably lower than has often been previously assumed. The most likely explanation is that women of this age are more likely to miscarry DS pregnancies than younger mothers.

Adult↗
PubMed2004

Is there a higher prevalence of pregnancy complications in a live-birth preceding the appearance of recurrent abortions?

OBJECTIVE: The present study was designed to evaluate the prevalence of pregnancy complications in a live-birth preceding the appearance of recurrent abortions. METHODS: A case-control study comparing women who had at least two consecutive spontaneous abortions after one live birth with matched controls, without recurrent abortions, was performed. Cases were recruited from the Recurrent Abortions Clinic. The women in the control group were matched by the following parameters: age, pregnancy order and having had a live birth in the same year as the study group. Four controls were matched for each case. The analysis focused on the characteristics of the live-birth preceding the recurrent abortions of the study group and the births of the matched controls. RESULTS: From Jan 2001 through Dec 2002, 140 women were examined in the Outpatient Clinic for Recurrent Abortions. Of these, 58 women who had a live-birth prior to at least two consecutive spontaneous abortions comprised the study group, which was compared with 232 controls. A statistically significant higher rate of preeclampsia (mild and severe) was found in a live-birth preceding recurrent abortions than in the matched controls (10.3 vs. 3.9%, p=0.047). In addition, a nonsignificant trend was found for higher rates of non-reassuring fetal heart rate patterns (8.6 vs. 3.0%, p=0.055) in this group. No other significant differences regarding maternal or neonatal complications such as placental abruption, intrauterine growth restriction, and intrauterine fetal death were noted between the groups. CONCLUSIONS: A live-birth preceding the appearance of recurrent abortions is associated with a higher rate of preeclampsia.

Abortion, Habitual↗
PubMed1999

Cumulative probability of clinical pregnancy and live birth after a multiple cycle IVF package: a more realistic assessment of overall and age-specific success rates?

OBJECTIVE: To provide an assessment of pregnancy and live birth probabilities for women presenting for in vitro fertilisation treatment for the first time, when committed in advance to have up to three cycles of treatment in one year. DESIGN: Up to three cycles of in vitro fertilisation within one year, committed in advance. SETTING: A tertiary referral centre for assisted reproduction. PARTICIPANTS: Two hundred and thirty-two women, undergoing a total of 536 cycles of in vitro fertilisation or intracytoplasmic sperm injection between August 1993 and December 1995. METHODS: Analysis of cumulative clinical pregnancy and live birth rates for women having IVF treatment for the first time and undertaking a three-cycle package, using the life-table approach. MAIN OUTCOME MEASURES: Cumulative clinical pregnancy and live birth rates. RESULTS: The cumulative probabilities of clinical pregnancy and live birth after two cycles of treatment were 38.2% and 33.2%, respectively, compared with 54.2% and 48.2%, respectively, after three cycles of treatment. Cumulative clinical pregnancy and live birth rates after three cycles of treatment for women up to the age of 40 years were 57.8% and 51.3%, respectively. Cumulative clinical pregnancy and live birth rates declined with increasing age (P = 0.02 and P= 0.01, respectively). CONCLUSION: The three-cycle package encourages couples to have multiple treatment cycles, thereby improving their ultimate chances of a live birth. The cumulative clinical pregnancy and live birth rates after such a package provide a more realistic assessment of overall and age-specific success rates after multiple treatment cycles.

Adult↗
PubMed1988

Maternal cigarette smoking, Down syndrome in live births, and infant race.

Previous studies have suggested that maternal smoking is negatively associated with a Down syndrome live birth. We analyzed the data of the U.S. Perinatal Collaborative Study in a search for racial variation in Down syndrome risk factors. There were 22 cases in 25,346 live births to smoking mothers (4/10,780 blacks, 18/13,320 whites, and 0/1,246 other races) and 42/29,130 live births to nonsmoking mothers (24/14,665 blacks, 14/11,694 whites, and 4/2,771 others). The crude overall rates per 1,000 live births were 0.4 in black smokers and 1.6 in black nonsmokers but 1.4 in white smokers and 1.2 in white non-smokers. Adjusted for maternal age, the summary relative risk for a Down syndrome live birth to a smoking mother was 0.2 in blacks (95% interval 0.1-0.7) but 1.2 in whites (95% interval 0.6-2.5). Stratification on variables associated with socioeconomic status or gestational age at time of entry into the study did not alter the racial difference. A comparison of smokers with those who never smoked revealed essentially the same trends. Among all nonsmokers the ratio of the maternal age-adjusted risks for a Down syndrome live birth in whites compared with blacks was 0.7 (95% interval 0.3-1.3), and among all smokers this ratio was 3.6 (95% interval 1.3-9.9). If the results are not attributable to statistical fluctuation or undetected confounding, then differences in the probability of intrauterine survival of the Down syndrome fetus would appear to be one plausible explanation for the difference.

Adolescent↗
PubMed1998

[An analysis on a relationship between perinatal mortality and live births of low birthweight, in Kumamoto Prefecture, 1968-1994].

The aims of this investigation were to describe the relationship between perinatal mortality rates and the proportions of live births among low birth weight (LBW) infants from 1968 to 1994, and to determine risk factors in infants of low birth weight. Using vital statistics from 1968 to 1994 of the Japanese government and the Kumamoto Prefecture and Maternal and Child Health Statistics of Japan from 1968 to 1995, perinatal deaths and live births of infants of low birth weight were studied according to national statistics criteria. In Japanese and Kumamoto Prefecture, there was an association between perinatal deaths and live births of LBW. The significant decline of perinatal mortality rates from 1968 to 1976, of which the fetal death ratio at 28 weeks and over mostly declined, was closely related to the decline of live births of LBW. In this period, the improvement of socioeconomic conditions and the comprehensive health care provided by the government contributed in improving perinatal mortality rates. From 1977 to 1988, the annual variation of Kumamoto was different from that of all Japan. Both perinatal mortality rates continued to decline due to a general decrease in early neonatal mortality rates. The number of Live births of LBW infants in Kumamoto prefecture increased in 1977 and once again started to decline in 1982. In 1977, the insufficient maternal-child health care and the increase of female workers contributed to increasing rates of live births of LBW. Advances in neonatal medicine contributed to the increase in survival rates of infants of LBW. Although, after 1982, the improvement of maternal-child health care and the perinatal care system contributed to the declining rates of live births of LBW. On the other hand, those rates in all Japan continued to gradually increase from 1977 to 1988. After 1989, perinatal mortality rates continued to decline, and live births of LBW continued to increase in both Kumamoto prefecture and all Japan. These results were contrary to the above results from 1968 to 1976. It was considered that medical advances in the care of pregnant women and neonates increased survival rates of the LBW. In future, the perinatal mortality rates will appear to approach a minimum constant, that is, a minimum of fetal death rates. It is important to reduce the number of LBW infants, particularly birthweight of 2000 g-2499 g, with maternal-child health care.

Birth Weight↗
PubMed2003

Thromboprophylaxis improves the live birth rate in women with consecutive recurrent miscarriages and hereditary thrombophilia.

The effect of thromboprophylaxis with low molecular weight heparin (LMWH), on the subsequent live birth rate, in thrombophilic women with recurrent miscarriage has not been sufficiently assessed. The present study is a cohort study undertaken to assess the effect of enoxaparin on the subsequent live birth rate in women with hereditary thrombophila. Eighty-five patients with three or more consecutive pregnancy losses and a hereditary thrombophilia subsequently conceived. Thirty-seven were treated with daily subcutaneous injections of enoxaparin 40 mg and 48 were not treated. The outcome of the subsequent pregnancy was assessed in both groups of patients in terms of live births or repeat miscarriage. Forty-seven of the 85 patients were subsequently delivered, 38 have miscarried. Twenty-six of the 37 pregnancies in treated patients (70.2%) resulted in live births, compared with 21 of 48 (43.8%) in untreated patients (P < 0.02, OR 3.03, 95% CI 1.12-8.36). The beneficial effect was seen mainly in primary aborters, i.e. women with no previous live births (P < 0.008, OR 9.75, 95% CI 1.59-52.48). This benefit was also found in patients with a poor prognosis for a live birth (five or more miscarriages), where the live birth rate was increased from 18.2% to 61.6%. However, the benefit was not statistically significant, probably due to the small number of patients. If the beneficial effects of enoxaparin are confirmed by additional studies, thromboprophylaxis can be recommended for patients with hereditary thrombophilia and recurrent pregnancy loss.

Abortion, Habitual↗
PubMed2005

Increasing likelihood of further live births in HIV-infected women in recent years.

OBJECTIVE: To examine how the subsequent childbearing of HIV-infected mothers enrolled in the European Collaborative Study (ECS) has changed over time and identify factors predictive of further childbearing. DESIGN: Prospective cohort study. SETTING: Centres in nine European countries included in the ECS, enrolled between end 1986 and November 2003. POPULATION: HIV-infected women (3911): 3693 with only one and 218 with subsequent live births. METHODS: Univariable and multivariable logistic regression analyses to obtain odds ratios (OR) and 95% confidence intervals (CI). Kaplan-Meier (KM) analyses to estimate cumulative proportions of women having a subsequent live birth. MAIN OUTCOME MEASURES: Subsequent live birth. RESULTS: In multivariable analysis adjusting for time period, ethnicity, maternal age and parity, black women were more likely [adjusted odds ratio (AOR) 2.45; 95% CI, 1.75-3.43], and women >30 years less likely (AOR 0.54, 0.37-0.80), to have a subsequent live birth. Time to subsequent live birth significantly shortened over time, with an estimated 2% of women having a subsequent live birth within 24 months of enrollment pre-1989 versus 14% in 2000-2003 (P < 0.001). Estimated time to subsequent live birth was shorter for black than for white women (P < 0.001). CONCLUSIONS: The likelihood of subsequent live births substantially increased after 1995 and birth intervals were shorter in women on HAART and among black women. Numbers are currently too small to address the issue of advantages and disadvantages in the management of subsequent deliveries.

Antiretroviral Therapy, Highly Active↗
PubMed1998

Severity of pelvic inflammatory disease as a predictor of the probability of live birth.

OBJECTIVE: Our aim was to study the association between severity of pelvic inflammatory disease at laparoscopy and the probability of achieving a live birth, while accounting for subsequent episodes of pelvic inflammatory disease. STUDY DESIGN: Beginning in 1960 a cohort of 1288 women in Lund, Sweden, who had clinical symptoms of acute pelvic inflammatory disease and who desired pregnancy was followed for up to 24 years. All participants underwent laparoscopy and were categorized by degree of salpingitis: mild (n = 371), moderate (n = 580), or severe (n = 337) pelvic inflammatory disease. Cumulative live birth rates, obtained by life-table analysis, and proportional hazards ratios were compared among women by severity of pelvic inflammatory disease, while accounting for subsequent episodes. RESULTS: The cumulative proportion of women achieving a live birth after 12 years was 90% for women with mild, 82% for women with moderate, and 57% for women with severe pelvic inflammatory disease. The occurrence of subsequent episodes in women with mild pelvic inflammatory disease did not diminish their long-term probability of live birth, whereas it significantly lowered the probability of live birth in women with severe pelvic inflammatory disease. Women with severe disease and subsequent episodes were eight times more likely to fail to achieve live birth compared with women with a single pelvic inflammatory disease episode with mild disease (relative risk 8.1; 95% confidence interval 3.0 to 22.2). CONCLUSIONS: Increasing severity of pelvic inflammatory disease correlates with a lower long-term probability of live birth. Subsequent episodes have a greater impact on women with severe pelvic inflammatory disease at the index episode compared with those with milder disease.

Adult↗
PubMed2002

Hereditary thrombophilias are not associated with a decreased live birth rate in women with recurrent miscarriage.

OBJECTIVE: To assesses the live birth rate without treatment in women with hereditary thrombophilia who have recurrent miscarriage and women without thrombophilia who have recurrent miscarriage. DESIGN: Prospective observational study. SETTING: Tertiary referral unit in university hospital. PATIENT(S): One hundred twenty women with thrombophilia and 65 women without thrombophilia. MAIN OUTCOME MEASURE(S): Number of live births or repeated miscarriages. RESULTS: Of the 185 patients, 44 with thrombophilia and 26 without thrombophilia have conceived. Nineteen of the 44 pregnancies (43.2%) in thrombophilia patients have terminated in live births, compared with 8 of 26 pregnancies (30.8%) in patients without thrombophilia. This difference is not statistically significant. CONCLUSIONS: Hereditary thrombophilia did not seem to affect the live birth rate in women with recurrent miscarriage.

Abortion, Habitual↗
PubMed2004

Cumulative first live birth after elective cryopreservation of all embryos due to ovarian hyperresponsiveness.

OBJECTIVE: To estimate cumulative chance for first live birth after elective pronuclear stage cryopreservation of all embryos due to ovarian hyperresponsiveness. DESIGN: Retrospective analysis with longitudinal follow-up. SETTING: Academic hospital. PATIENT(S): Thirty subjects with elective cryopreservation of all embryos due to ovarian hyperresponsiveness. INTERVENTION(S): Elective cryopreservation of all embryos at the pronuclear stage (n = 30) and subsequent cryopreserved-thawed ET (n = 51). MAIN OUTCOME MEASURE(S): Cumulative chance for first live birth. RESULT(S): Cumulative chance for first live birth was 77% when analyzed by intention to treat and 82% by treatment with ET. Nearly 40% of live births were multiple. CONCLUSION(S): Cumulative first live birth increased with repetitive ET after elective pronuclear stage cryopreservation of all embryos due to ovarian hyperresponsiveness. Multiple births, however, were frequent. In the context of initial ET attempts in young women, transfer of no more than two cryopreserved-thawed embryos is advised.

Adult↗
PubMed2002

A nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility.

OBJECTIVE: To establish whether initial screening characteristics of normogonadotropic anovulatory infertile women can aid in predicting live birth after induction of ovulation with clomiphene citrate (CC). DESIGN: Prospective longitudinal single-center study. SETTING: Specialist academic fertility unit. PATIENT(S): Two hundred fifty-nine couples with a history of infertility, oligoamenorrhea, and normal follicle-stimulating hormone (FSH) concentrations who have not been previously treated with any ovulation-induction medication. INTERVENTION(S): 50, 100, or 150 mg of oral CC per day, for 5 subsequent days per cycle. MAIN OUTCOME MEASURE(S): Conception leading to live birth after CC administration. RESULT(S): After receiving CC, 98 (38%) women conceived, leading to live birth. The cumulative live birth rate within 12 months was 42% for the total study population and 56% for the ovulatory women who had received CC. Factors predicting the chances for live birth included free androgen index (testosterone/sex hormone-binding globulin ratio), body mass index, cycle history (oligomenorrhea versus amenorrhea), and the woman's age. CONCLUSION(S): It is possible to predict the individual chances of live birth after CC administration using two distinct prediction models combined in a nomogram. Applying this nomogram in the clinic may be a step forward in optimizing the decision-making process in the treatment of normogonadotropic anovulatory infertility. Alternative first line of treatment options could be considered for some women who have limited chances for success.

Abortion, Spontaneous↗
PubMed2004

The significance of pulmonary interstitial emphysema in live birth determination.

The utility of pulmonary interstitial emphysema (PIE) in live birth determination is not well established. Because the distinction between live birth and stillbirth may be important in criminal proceedings, we undertook this study to investigate the relationship between the histologic finding of PIE and live birth. Sixty-six cases of infant death were retrieved and compared with 21 stillborn infants. Histologic sections of the lungs were characterized as "florid PIE," "equivocal PIE," or "absent PIE." Sixteen cases of florid PIE were identified, all in live born infants. Forty-seven cases of equivocal PIE were found in 36 live born and 11 stillborn infants. In 24 cases (14 live born infants and 10 stillborns), no PIE was identified. We examined the relationship between florid PIE in infants with sudden infant death syndrome (SIDS) or "sudden unexpected death in infancy, manner undetermined" (SUDI), and also its relationship to other variables. No association was found. The presence of equivocal PIE may be an artifact of tissue processing. Florid PIE is found only in live born infants. No correlation between the presence of florid PIE and cause of death could be determined.

Female↗
PubMed2005

Cumulative live birth rates in cohorts of patients treated with in vitro fertilization or intracytoplasmic sperm injection.

OBJECTIVE: Follow-up of IVF/intracytoplasmic sperm injection (ICSI) patients to obtain accurate information concerning chances of live birth as well as early treatment dropout. Comparison of the cumulative pregnancy rates, established in cohorts, with those estimated with life table analysis to determine which method provides the most accurate data without overestimation. DESIGN: Retrospective longitudinal cohort study. SETTING: Academic medical IVF center. PATIENT(S): All 750 patients from the Leiden IVF center and another 706 patients from cooperating clinics starting IVF/ICSI treatment in the period 1996-2000. INTERVENTION(S): All observations were part of standard IVF/ICSI and cryopreservation protocols. MAIN OUTCOME MEASURE(S): Endpoints of this study were a first live birth or termination of treatment. Treatment cycles were followed until the end of 2002, pregnancy follow-up through September 2003. RESULT(S): The cumulative live birth rate for the Leiden cohort was 59.1%. In yearly cohorts this varied from 54.8% to 67.1%. Cumulative live birth rates were 61.8%-63.2% for unexplained infertility (n = 229), endometriosis (n = 19), and andrologic indication (n = 223). For tubal (n = 129) and hormonal (n = 46) indications the rates were 55.8% and 45.7%, respectively. The group of egg donation or surrogacy (n = 10) reached 40.0%, and patients with two or more indications (n = 84) 56.0%. For women < or = 35 years of age the cumulative live birth rate was 64.6%, for women 36-39 years of age it was 48.7%, and for women 40-42 years of age 31.0%. CONCLUSION(S): In contrast to estimation of expected cumulative pregnancy rates the cohort measurement does not overestimate success rates. It accurately reflects chances of both live birth as well as early treatment dropout. The cumulative live birth rate was 59.1%. Over time results improved and the contribution of cryopreservation increased.

Adult↗