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PubMed2004

Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial.

PURPOSE: This prospective, multicenter trial was designed to assess the safety and effectiveness of a novel technique in the treatment of outlet obstruction caused by the combination of intussusception and rectocele by using a double-transanal, 33-mm circular stapler. METHODS: From January to October 2001, 90 patients with outlet obstruction were operated on and followed (mean, 16.3 +/- 2.9 months) by the validated Constipation Scoring and Continence Grading Systems, clinical examination, defecography, and anorectal manometry. Anal ultrasound also was performed in 58 multiparous patients. RESULTS: Operative time and hospital stay were short (mean, 43.3 +/- 8.7 minutes and 2.1 +/- 0.8 days, respectively), and postoperative pain was minimal. The mean time to resume normal activity was 10.2 +/- 4.5 days. Complications were 17.8 percent fecal urgency, 8.9 percent incontinence to flatus, 5.5 percent urinary retention, 4.4 percent bleeding, 3.3 percent anastomotic stenosis, and 1.1 percent pneumonia. All constipation symptoms significantly improved (P < 0.001) without worsening of anal continence. No patient complained of dyspareunia. At postoperative defecography, all patients had a double incisure of the lower rectal outline in the site of anastomosis, with the disappearance of both intussusception and rectocele. Anal pressure was not significantly modified, whereas rectal compliance was restored (P < 0.05). No lesions of anal sphincters caused by the operation were found in multiparous patients. The outcome at one year was excellent in 48 of 90 patients, good in 33, fairly good in 5, and poor in 4. CONCLUSIONS: This novel technique seems to be safe and effective in the treatment of outlet obstruction caused by the combination of intussusception and rectocele. Randomized trials are required to confirm these findings.

Adult↗
PubMed1992

A randomized trial of prostaglandin E2 in a controlled-release vaginal pessary for cervical ripening at term.

OBJECTIVE: The purpose of this study was to determine if prostaglandin E2 in a controlled-release vaginal pessary can produce cervical ripening at term. STUDY DESIGN: This was a double-blind, randomized, placebo-controlled study conducted at a university center and involving 81 patients with 42 receiving active agent. Categoric data were analyzed by Pearson's chi 2 or logistic regression. Continuous variables were analyzed by analysis of variance and the F test. RESULTS: Prostaglandin E2 was significantly better than placebo at cervical ripening and at decreasing the time to rupture of membranes, the time to onset of labor, the need to give oxytocin, and the time to vaginal delivery. Multiparous women benefitted more than primiparous ones. The cesarean section rate decreased only for multiparous women. Uterine hyperstimulation occurred only with prostaglandin E2 and after the onset of labor. CONCLUSIONS: Prostaglandin E2, when administered in a controlled-release vaginal pessary, is affective in producing cervical ripening at term. This agent should be used on inpatients who are under continuous monitoring and it should be removed at the onset of labor.

Cervix Uteri↗
PubMed1992

Eclampsia. VII. Pregnancy outcome after eclampsia and long-term prognosis.

OBJECTIVES: Our goal was to report pregnancy outcome and long-term prognosis after eclampsia. STUDY DESIGN: Women whose pregnancies were managed at the E.H. Crump Women's Hospital between August 1977 and April 1989 were studied. A total of 223 women with eclampsia underwent follow-up for an average of 7.2 years. Thirteen had preexisting hypertension and 210 were normotensive (31 were multiparous and 179 were nulliparous). RESULTS: Among these women 23 who were multiparous and 159 who were nulliparous had 366 subsequent pregnancies: 22% of pregnancies were complicated by preeclampsia, 1.9% by eclampsia, and 2.5% by abruptio placentae; 2.7% resulted in perinatal death. Within the nulliparous group, women who had eclampsia before 37 weeks' gestation in the index pregnancy had significantly higher incidences of preeclampsia and poor perinatal outcome in subsequent pregnancies as compared with those who had eclampsia at greater than or equal to 37 weeks' gestation; the highest incidence of obstetric complications occurred in those having eclampsia at less than or equal to 30 weeks. Twenty of the 210 normotensive women (9.5%) had chronic hypertension on follow-up; the highest incidence (17.9%) being in those with eclampsia at less than or equal to 30 weeks and the lowest incidence (4.8%) in those having eclampsia at greater than or equal to 37 weeks. Women with eclampsia who had preeclampsia in subsequent pregnancies had a higher incidence of chronic hypertension as compared with those who were normotensive in subsequent pregnancies (25% vs 2%, p less than 0.0001). Long-term maternal complications included dialysis required in one patient and one case of cardiomyopathy in women with chronic hypertension; there was one maternal death in a women with chronic hypertension. None of the women had evidence of neurologic deficit or seizures during follow-up. CONCLUSIONS: These findings should be used in counseling women who have had eclampsia and are considering future pregnancies.

Adult↗
PubMed1995

Risk factors for the development of preterm premature rupture of the membranes after arrest of preterm labor.

OBJECTIVE: Our purpose was to determine risk factors predictive of preterm premature rupture of the membranes in women treated for preterm labor with intact membranes. STUDY DESIGN: Women with intact membranes participating in a National Institute of Child Health and Human Development multicenter randomized trial of adjunctive antibiotic therapy for preterm labor (24 to 34 weeks) were studied (n = 275). After randomization, 22 women continued to have contractions and were delivered of their infants. The remaining 253 women whose contractions had ceased composed our study population. Preterm premature rupture of the membranes was diagnosed if ruptured membranes occurred > or = 1 hour before the onset of recurrent preterm labor. As part of the study protocol, most women underwent amniocentesis on admission. RESULTS: Preterm premature rupture of the membranes developed in 44% women (17.4%). Women who had preterm premature rupture of the membranes were more likely to be black (p = 0.004), to be multiparous (p = 0.014), to have a history of abortion(s) (p = 0.001), to have had a preterm birth(s) (p = 0.036), to have early onset preterm labor (p = 0.04), to have more advanced cervical dilatation (p = 0.0001), to have one or more amniotic fluid markers suggestive of infection (p = 0.01, odds ratio 4.2), and to have positive amniotic fluid cultures (p = 0.0007, odds ratio 27). Assignment to antibiotic therapy did not prevent preterm premature rupture of the membranes in the 253 women randomized or in the 16 women with a positive amniotic fluid marker(s) of infection. CONCLUSION: Black race, multiparity, a history of abortion or preterm birth, advanced dilatation, and a positive amniotic fluid marker(s) are associated with preterm premature rupture of the membranes in women with preterm labor. Antibiotic treatment did not prevent preterm premature rupture of the membranes.

Abortion, Spontaneous↗
PubMed1986

Induction of labor in postterm pregnant women.

We have studied the outcome of labor induction in 145 postterm pregnant women in whom gestational age was properly assessed by ultrasound scanning. The induction techniques were adapted to the cervical states of the patients. Seventy-five patients (32 nulliparous and 43 multiparous) with favorable cervical states were successfully induced with intravenous oxytocin. In this group the frequency of Caesarean section was 2%. Seventy patients (45 nulliparous and 25 multiparous) with unripe cervices received 0.5 mg PGE2 in viscous gel intracervically to prime the cervix and to induce labor; 38 (52%) were induced into labor after a single PGE2-gel application whereas 26 (48%) needed labor augmentation with intravenous oxytocin after PGE2-gel obtained cervical ripening. In 6 of the 20 patients the cervix did not ripen and the PGE2-gel application had then to be repeated. The frequency of cesarean sections was 11%. In 5 out of the 145 patients (4%) the fetuses had signs of intrauterine growth retardation (IUGR) as assessed by ultrasound scanning, and postmaturity as verified by pediatric examination at delivery. All these fetuses belonged to nulliparous women with unripe cervices and all had to be delivered instrumentally (3 by cesarean section and 2 by ventouse) indicating the fragility of these children. If postterm pregnancy is complicated by an unfavorable cervical state intracervical application of PGE2-gel seems to be an efficient method to prime the cervix and to induce labor. In most patients an uncomplicated vaginal delivery can be achieved by this procedure. However, nulliparous women with unfavorable cervices and signs of IUGR constitute a high risk group of patients at labor induction.

Adolescent↗
PubMed1988

Obstetric complications of macrosomic babies in African women.

A prospective analysis has been made on 145 consecutive deliveries resulting in babies weighing 4.5 kg and above delivered at the University of Nigeria Teaching Hospital (U.N.T.H.), Enugu, over a 1-year period (1985). Babies weighing 4.5 kg and over are regarded as macrosomic babies. The incidence of macrosomic babies in this study is 11 per thousand deliveries or 1 in 90. Factors that predisposed to the birth of macrosomic babies include: excessive weight gain during the course of pregnancy, tall height of the woman, multiparity and prolonged gestation. Diabetes mellitus was not a significant factor. Complications include prolonged labor, post-partum hemorrhage, ruptured uterus, shoulder dystocia and an increased perinatal mortality rate. Maternal mortality was also increased. Ninety percent of the multiparous women achieved spontaneous vaginal delivery while only 42% of the primigravidae achieved vaginal delivery. The implications are discussed.

Adult↗
PubMed1990

Uterine rupture--an analysis of 81 cases in Conakry/Guinea.

Eighty-one cases of uterine rupture in Conakry/Guinea are analyzed. With an incidence of 0.84%, i.e. 1 per 119 deliveries, uterine rupture is still a common problem in this region. In this analysis fetal mortality was found to be 75.3% and maternal mortality 20.9%. Mortality rates were statistically higher after hysterectomy than after repair. Other etiologic factors were extreme multiparity and an inadequate transfer system to the obstetric centers. A reduction of uterine rupture rates can be achieved by prevention of extreme multiparity (more than 4 deliveries) and of home deliveries and decentralization of obstetric services into peripheral units and villages.

Adolescent↗
PubMed1990

Three new species of Monocotyle (Monogenea: Monocotylidae) from the stingray, Himantura uarnak (Rajiformes: Dasyatidae) from the Great Barrier Reef: phylogenetic reconstruction, systematics and emended diagnoses.

Three new species of Monocotyle were found on the gills of the coachwhip stingray, Himantura uarnak (Rajiformes: Dasyatidae) collected at Heron Island, Great Barrier Reef, Australia (23 degrees 27' S, 151 degrees 55 'E). Monocotyle helicophallus new species, Monocotyle multiparous new species and Monocotyle spiremae new species all have a single testis and are distinguished from other described Monocotyle species by size of body and hamulus and number of coils of the sclerotized male copulatory organ (21-22, three to four and 29-42, respectively). Monocotyle helicophallus new species is characterized by several muscular genital papillae, one of which is traversed by the ejaculatory duct; M. spiremae new species is distinguished by a sclerotized accessory structure associated with the distal end of the male copulatory organ, a vaginal sclerite and a conspicuous spherical, ejaculatory bulb; M. multiparous new species is distinguished by a large number of retained, thin-shelled eggs, many of which contain a fully developed oncomiracidium. A phylogenetic analysis of the 14 described species of Monocotyle utilizing 13 characters (11 binary and two multistate) produced the most parsimonious cladogram involving 18 steps with a consistency index of 0.78, two homoplasies and four unresolved polychotomies. Emended diagnoses of the Monocotylinae and Monocotyle are provided.

Animals↗
PubMed1977

An indirect anti-immunoglobulin rosetting reaction to detect alloantibodies to human lymphocytes.

A test is reported which detects alloantibody, absorbed onto the surface of human lymphocytes from multiparous antisera, by means of a red cell rosette assay. The red cells, trypsinised ox, are coupled with anti-immunoglobulin using chromic chloride. The antiglobulin used is rabbit anti-human IgG (Fc), chosen to avoid reaction with the surface immunoglobulin naturally present on human B lymphocytes. The reaction is termed the Indirect Anti-immunoglobulin Rosetting Reaction (IARR). The IARR is shown to be specific in the following ways: anti-immunoglobulin coupled ox cells do not react with normal human lymphocytes nor with lymphocytes treated with non-reactive serum. Red cells coupled with normal rabbit IgG do not react with normal or alloantibody coated lymphocytes. Multiparous sera (reactive with other individuals) do not react with cells of the serum donor in the IARR. Finally, the coupled red cells do not usually react with lymphocytes which have absorbed immune complexes onto their Fc receptors. The IARR is shown to be more sensitive than a standard cytotoxic test for detection of alloantibody. Several possible applications of the IARR are discussed.

Isoantibodies↗
PubMed1983

Life event scales for obstetric groups.

Although associations have been described between life events and the incidence of perinatal complications, research has been limited by the lack of life event scales appropriate to obstetric groups. We report the development of such scales for primiparous and multiparous women. High ranking items from existing general life event scales as well as items relevant only to pregnant women were included. The degree of resultant distress was rated by visual analogue scales, and the frequency of each life event was assessed. High internal consistency was demonstrated for each of the scales and their general utility is suggested by the similar rank ordering of ratings in the primiparous and multiparous samples. Approximately one-third of the highest rating items on the scales were pregnancy related, supporting the view that scales measuring the stress of life events should include items relevant to the particular group of respondents.

Adult↗
PubMedDate not supplied

The effects of the socioeconomic status on the perinatal outcome of grand multipara.

Grandmultiparity has been considered as an obstetric hazard both to the mother and the fetus. Since high paritius tend to be more common in the lower socioeconomic groups, the effect of the socioeconomic status on perinatal outcome was evaluated in this study. This survey covers all the deliveries in Israel (22,815) in a 3 month period. The 1542 grand-multiparous women were divided into two groups: low socioeconomic group (947) and high socioeconomic group (595). Perinatal mortality and low birth weight were found to be in correlation with low socioeconomic status but not with grand multiparity. Maternal diseases complicating pregnancy were found to be significantly more common for grand multipara for both socioeconomic groups. This study shows that the grave association of parity and mortality found for the total population was due to the predominance of parturients of low socioeconomic class in the high birth order group.

Adult↗
PubMed1996

A longitudinal study of maternal hemodynamics during normal pregnancy.

OBJECTIVE: To investigate the maternal hemodynamic changes that occur during normal pregnancy. METHODS: Serial hemodynamic investigations were performed throughout normal pregnancy by thoracic electrical bioimpedance monitoring in 50 healthy women. Analysis of variance with repeated measurements was used to evaluate the time course of a number of hemodynamic indies. RESULTS: The mean heart rate (+/- standard error [SE]) increased gradually from 87 +/- 2 beats per minute at 10-18 weeks' gestation to 92 +/- 1 beats per minute at 34-42 weeks' gestation. Mean arterial pressure decreased significantly after 14 weeks' gestation and increased significantly after 29 weeks' gestation. During the third trimester, mean cardiac output and mean stroke volume decreased, and mean systemic vascular resistance increased significantly. The course of cardiac output during the third trimester was not uniform in all women; it increased in nine and decreased in 41 women. A significantly higher mean cardiac output was found in nulliparous women compared with multiparous women (mean difference +/- SE 0.76 +/- 0.33 L/minute). The mean (+/- SE) cardiac output increased significantly from 6 (5.49 +/- 0.16 L/minute) to 12 weeks' postpartum (5.91 +/- 0.19 L/minute). CONCLUSION: Mean cardiac output and mean stroke volume decreased in late pregnancy. A significant difference in mean cardiac output was observed between nulliparous and multiparous women. Cardiac output usually, but not invariably, declined during the third trimester.

Adult↗
PubMed1986

The importance of vaginal-cervical stimulation for maternal behaviour in the rat.

Non-parturient female rats were primed with oestrogen and given 5 minutes of vaginal-cervical stimulation before foster pups were introduced to them. Virgin and multiparous Wistar rats were used and half the females were ovariectomised. Half of each group was given vaginal-cervical stimulation and the other half was handled for the same time period. An animal was designated "maternal" if it showed all components of maternal behaviour (i.e., retrieving, licking, and crouching). A group of normal, parturient females was observed to compare their normal maternal behaviour with that of experimental animals. Significantly more intact multiparous females showed immediate maternal behaviour after stimulation (75%) than after handling (30%, p less than 0.04). However, virgin females showed no maternal behaviour in response to vaginal-cervical stimulation. This study shows that sensory input from the vagina plays an important role in the immediate induction of maternal behaviour, but this effect is synergistic with that of hormones and experience.

Animals↗
PubMed1988

Iron deficiency, pregnancy and breast-feeding in the Republic of Niger.

Body iron stores in 173 African women were evaluated by serum ferritin radioimmunoassay. The population studied was selected only by its accessibility in Guesheme, Dosso county, and other villages in Niamey and Dosso counties, Republic of niger. Iron fumarate (Fumafer) was systematically administered orally (400 mg/d) for one month. 95 women were revisited at the end of treatment. 22% of revisited women were iron deficient before treatment (serum ferritin less than 12 ng/ml); after one month of treatment only 8% had serum ferritin below the threshold value of 12 ng/ml, in spite of the low doses of iron fumarate administration; and the response to treatment was more significant in multiparous women. These results emphasize the very high prevalence of iron deficiency in the population studied, and demonstrate the need for systematic iron treatment of the multiparous women living in rural areas. The efficacy of low doses of iron fumarate is clear.

Adolescent↗
PubMed1993

Cytometric study of the female Syrian hamster gallbladder epithelium following sex steroid administration.

This report is a cytometric study of the female Syrian hamster gallbladder epithelium following 1-, 2-, and 3-month administration of female sex steroids. Nulliparous, multiparous, young, old and pregnant hamsters were used in this study. A 1 month treatment with estrogen alone significantly increases the nuclear volume of the gallbladder epithelial cells, while E + P treatment significantly affects the nuclear volume only after a 2 month treatment. On the other hand, E + P and P treatments significantly increase the cell volumes as compared to the E-treated groups, this effect is most striking following the 1 month period. Prolonged sex steroid treatment (2 and 3 month) does not appear to influence the gallbladder epithelial cell and nuclear volumes as dramatically as that observed following the 1 month treatment. The nulliparous, progesterone-treated hamsters appear to have a greater cytoplasmic volume than the multiparous group and this is substantiated by the bulging apices and the luminal cellular excrescences observed with scanning and transmission electron microscopy. These observations are similar to those reported in ovariectomized hamsters (Gilloteaux et al., 1992). Further, the gallbladder epithelial cells and nuclei of the older female hamsters demonstrate an accentuated response to a 1 month sex steroid treatment as compared to the younger hamsters for the same treatment duration. These results enable us to hypothesize that changes induced by a short term sex steroid treatment participate in the gallstone nucleation process, while longer duration of the treatments contribute to progressive enlargement and accumulation of gallbladder calculi.

Animals↗
PubMed1984

Endocervical carcinoma: a study of 23 patients with clinical-pathological correlation.

Twenty-three patients with endocervical carcinomas diagnosed at the Mount Sinai Medical Center during the last 5 years were reviewed (clinical history and histologic material). The tumors were endocervical-type adenocarcinomas, adenosquamous carcinoma, mucinous (colloid), papillary, and clear cell carcinomas. Eight associated carcinomas in situ were found. Younger patients tended to have more adenosquamous carcinomas, perhaps related to the frequency of squamous metaplasia in sexually active women. Twenty-two out of twenty-three patients were multiparous, many of them grand multiparas. In two patients the tumor followed parturition, and in two patients it was found in the cervical stump. No association with oral contraceptives was found. Multiparous women seem to be at increased risk for this malignancy. The early detection of endocervical carcinoma is based on the recognition of dysplasia and adenocarcinoma in situ in the biopsy material. This is of particular significance in the endocervical cancer because its location often prevents early detection.

Adenocarcinoma↗
PubMed1984

Photoperiodic alteration of postpartum reproductive function in suckled cows.

Three experiments were conducted using a total of 41 cows to determine if photoperiod modulates the establishment of postpartum estrous cycles and conception. Cows calving in the autumn and winter were exposed to either 18 hr light/day (18L:6D) or natural photoperiods. In Exp. 1, cows receiving 18L:6D had shorter (P<0.025) intervals from calving to estrus (61 +/- 3.8 days) than cows not receiving supplemental light (154 +/- 23.9 days). The same was true for primiparous cows in Exp. 2 (76 +/- 5.5 days vs 153 +/- 38.0 days; P<0.06) but not for the multiparous cows in Exp. 2 (56 +/- 5.2 days vs 40 +/- 7.4 days) or for all cows in Exp. 3 (60 +/- 10.1 days vs 70 +/- 13.5 days). Because conception rate was higher for cows exposed to 18L:6D for the multiparous cows in Exp. 2 and all cows in Exp. 3, interval to conception was significantly shorter for animals exposed to 18L:6D in all experiments. Generally, interval from calving to uterine involution was also reduced by exposure to 18L:6D. No effects of photoperiod were observed on body weight changes, serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) or estradiol or on estradiol-induced release of gonadotropins. It was concluded that in certain situations day length can hasten estrus and conception in postpartum cows. The effect of photoperiod interacts with other conditions, one of which is parity. The endocrine basis for these effects are not known.

Journal Article↗
PubMed1985

Effects of 6-MBOA on reproductive function in ponies, mice, rats and mink.

The effect on reproduction of the plant derivative 6-methoxybenzoxazolinone (6-MBOA), which stimulates reproductive function in voles, was tested in pony mares, laboratory mice and rats, and mink. There was not a significant effect of intravenous injections of 6-MBOA on the ovarian follicles during the transition between the anovulatory and ovulatory seasons in mares. No significant effect of intraperitoneal injections of 6-MBOA on the weight of uterus or ovaries was found in eight-week-old mice, failing to confirm the results of an earlier report. In immature white rats, 6-MBOA treatment resulted in an increase in uterine weight (P<0.05) at the lowest dose tested (0.03 mug/rat; mean for controls, 34 +/-2 mg; treated, 47 +/-5 mg). However, no significant effect was found on the weights of the ovaries and other glands or in coded scores for ovarian stimulation and uterine fluid distention. Adding 1.5 mg 6-MBOA to the daily feed ration of mink beginning two weeks before the mating season did not affect the mean number of kits born. Nulliparous female mink had smaller (P<0.001) litter size than multiparous females. In addition, of the mink that whelped, there were more (P<0.01) nulliparous females (25 118 ) than multiparous females (9 144 ) that lost one or more kits within 48 hours. These results, however, were not altered by 6-MBOA treatment.

Journal Article↗