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PubMed2005

Oestrus synchronisation of rabbit does at early post-partum by doe-litter separation or ECG injection: Reproductive parameters and endocrine profiles.

Inseminating rabbit does at early post-partum, in combination with early weaning, can increase prolificacy (total kits born and still born per parturition) and decrease parturition intervals. Oestrus synchronisation increases fertility and prolificacy, while decreasing the number of inseminations required for gestation. However, little is known about the effectiveness of different oestrus synchronisation methods at early post-partum. In this study, does (n = 138) were artificially inseminated nine times (over a period of 1 year, kits weaned at 25 days), on day 4 post-partum after separation from the litter (for 48 or 24 h) or 48 h after 25 UI eCG injection. Plasma levels of prolactin and estradiol were also evaluated in a subsample of 12 multiparous lactating does per treatment, on days 2, 3 and 4 post-partum. The three treatments increased overall fertility of multiparous females compared to controls (which were not synchronised), but there were no differences among treatments in total kits born or stillborn. Does treated with eCG had a higher culling rate. The interval between parturitions and the number of inseminations required for gestation tended to decrease with increasing number of inseminations. In lactating does, there was an interaction between treatment and insemination order. Fertility decreased with increasing inseminations in eCG does but tended to increase above control values in the separated does until the fourth insemination. Control lactating does had significantly less kits per parturition compared to treatments, but eCG lactating does had more stillborn kits. Oestradiol levels increased on day 4 post-partum in all synchronised lactating does (and immediately before artificial insemination in 48 h doe-litter separation), so ovarian activity could be stimulated at early post-partum using all treatments. However, the increase could not be explained by prolactin levels, since there were no effects of suckling absence on plasma prolactin in separated does. In conclusion, separating does from the litter before insemination can be just as effective as eCG treatment, especially during for the first four inseminations.

Animals↗
PubMed2006

First reproductive experience persistently affects spatial reference and working memory in the mother and these effects are not due to pregnancy or 'mothering' alone.

Pregnancy and motherhood are life-altering events that result in a number of hormonal, neural and behavioral changes in the mother. Motherhood has been shown to influence spatial learning and memory performance of the mother. In turn new research has shown that reproductive experience (number of times pregnant and mothered) plays a significant role on spatial learning and memory performance. How long these changes persist after weaning and the role of pregnancy and/or mothering on these changes have yet to be fully investigated. The present study aimed to determine whether enhanced spatial working and/or reference memory in the mother is evident long after weaning and whether these effects are due, in part, to pregnancy or 'mothering' alone. Five groups of age-matched rats: multiparous, primiparous, nulliparous, pregnant-only and sensitized rats were tested approximately 1 month after weaning/pup-exposure, or 55 days after birth, on the spatial working/reference version of the radial arm maze. Results show that regardless of error type (reference or working memory errors), primiparous rats make fewer errors compared to multi- and nulli-parous rats, with a trend to enhanced memory compared to sensitized rats. In addition, pregnant-only rats completed the task on significantly fewer days than primiparous, multiparous, nulliparous and sensitized rats. Clearly the combination of first pregnancy and first mothering experience has a significant impact on hippocampus-dependent learning and memory performance in the mother.

Analysis of Variance↗
PubMed2006

Induction of second trimester abortion (12-20 weeks) with mifepristone and misoprostol: a review of 386 consecutive cases.

DESIGN: A retrospective analysis of 386 women who underwent termination of pregnancy between 12 and 24 weeks' gestation. METHODS: Each woman received 200 mg mifepristone orally followed by vaginal misoprostol 800 microg 36 to 48 h later. Three hours after the initial misoprostol administration, 400-microg doses of vaginal misoprostol were administered every 3 h, to a maximum of four doses in 24 h. If abortion failed, 200 mg mifepristone is given again 3 h after the last misoprostol dose, followed by 12 h of rest before vaginal misoprostol administration is repeated as per previous course of treatment. RESULTS: Overall, 97.9% and 99.5% of the women aborted within 24 and 36 h, respectively. The median induction-to-abortion interval was 6.7 h (range: 1.4-73.8 h), and nulliparous women took significantly longer time to abort (6.0 h in multiparous women compared to 7.6 h in nulliparous women; p<.0001). One woman failed to abort within 48 h. Surgical evacuation of the uterus was performed in 5% of women for incomplete abortion or retained placenta. Multiparous women were less likely to need analgesic administration for pain relief, and to experience vomiting and diarrhea, than nulliparous women. CONCLUSION: The combination of 200 mg mifepristone and vaginally administered misoprostol is a safe, effective and noninvasive regimen for termination of pregnancy between 12 and 20 weeks.

Abortifacient Agents, Nonsteroidal↗
PubMed2004

The nature of touch in mothers experiencing maternity blues: the contribution of parity.

BACKGROUND: Maternal touch (MT) is an essential part of the initial contact between the mother and her newborn and has developmental effects on the child. MT is known to be reduced in postpartum depression (PPD). The nature of MT in mothers experiencing maternity blues and the effect of parity are still unknown. STUDY DESIGN: Seventy-five mothers were recruited from the ongoing series of deliveries. SUBJECTS: The participating mothers were observed during interaction with their newborns on the second-day postpartum. Touching behavior was scored on-line according to the Touch Scoring Instrument, which includes nine types of MT. Mothers were categorized as exhibiting maternal blues according to Stein's depression scale. OUTCOME MEASURE: Touch Scoring Instrument. RESULTS: Primiparous mothers with blues avoided all types of touch whereas multiparous mothers with blues provided firm touch and holding. All mothers with blues avoided proprioceptive touch. Multiparous mothers without maternal blues provided various types of touch including affectionate holding and matter-of-fact touch whereas primiparous mothers without blues mostly provided holding. CONCLUSIONS: Mothers with maternity blues on day 2 exhibited a pattern of MT similar to that known to characterize postpartum depression. Mothers without blues are able to provide developmental touch in a manner known to facilitate CNS stability and newborn adjustment to the extra-uterine world. Parity modulates the effect of maternity blues on MT and buffers the withdrawal effect of depression. Maternal touch could be used as a diagnostic tool for detection of mothers at risk in a timely manner. Touch interventions, which were previously demonstrated in PPD mothers, may be utilized in an earlier stage postpartum.

Adolescent↗
PubMed2004

Induction of labor in pregnancies with suspected large-for-gestational-age fetuses and unfavorable cervix.

OBJECTIVES: To evaluate our single-center, single-team experience with induction of labor in pregnancies with suspected large for gestational age (LGA) fetuses. STUDY DESIGN: A retrospective case-controlled design was used. Non-diabetic patients with a suspected LGA fetus (estimated fetal weight > or =90th percentile) (group 1, n = 135) were compared with healthy patients admitted for elective induction of labor for either post-date pregnancy or a subjective perception of decreased fetal movements in the presence of normal fetal heart monitoring and biophysical profile (group 2, n = 326), and with healthy women with normal pregnancies and spontaneous onset of labor (group 3, n = 574). RESULTS: There were no between-group differences in maternal age, parity, number of prostaglandin E2 (PGE2) tablets used, instrumental delivery rate or Apgar scores. The rate of cesarean section (CS) was significantly higher in the study group (33.3%) than in group 2 (17.8%, P = 0.001) and group 3 (10.6%, P = 0.004), although this difference disappeared when the multiparous women were analyzed separately (study group: n = 58, 10.3% versus group 2: n = 169, 7.7% and group 3: n = 308, 7.8%, P = 0.6). A logistic regression model (R2 = 0.385, P < 0.001) was used to control for maternal and gestational age, nulliparity rate, number of PGE2 tablets used, birth weight, and diagnosis (group 1 versus group 2) as predictors of mode of delivery. On stepwise (forward-likelihood) analysis, only nulliparity (odds ratio (OR) 10.0, 95% confidence interval (CI) 2.8-35.6, P < 0.001) and maternal age (OR 1.2, 95% CI 1.06-1.36, P = 0.002) were independently and significantly associated with increased risk of CS. CONCLUSIONS: Induction of labor for suspected LGA fetuses, if performed at all, should be reserved for multiparous women.

Adult↗
PubMed2006

Ultrasonographic and Doppler velocimetric evaluation of the levator ani muscle in premenopausal women with and without urinary stress incontinence.

OBJECTIVES: The objective was to evaluate the cross-sectional area (CSA) and the Doppler velocimetric parameters of the levator ani muscle vessels in premenopausal women with and without urinary stress incontinence. STUDY DESIGN: Sixty-three premenopausal women constituted three groups: GI (nulliparous), GII (continent multiparous), and GIII (incontinent multiparous). The patients had undergone transperineal ultrasound in which the CSA was measured and Doppler velocimetry was performed. The examination was repeated by a second observer using the same procedure. RESULTS: There was a statistically significant correlation between the measurements of the observers I and II regarding all the parameters studied, except for the A/B ratio in GIII. The CSA was significantly greater in GI and GII than in GIII. As far as Doppler velocimetry is concerned there were no differences in the Doppler velocimetric indices among the three groups. Concerning the absent end diastolic shift, it was observed that there was a significantly greater incidence of such findings in GI+GII (continent women) towards GIII (incontinent women). CONCLUSIONS: The CSA evaluation and the Doppler velocimetry of the levator ani muscle vessels were highly reproducible. The CSA was higher in continent women and the frequency of the absent end diastolic shift was higher in incontinent women.

Adolescent↗
PubMed2003

Fecal incontinence after high-risk delivery.

OBJECTIVE: To investigate the prevalence of and factors associated with fecal incontinence and its precursors among high-risk women at 12 months postpartum. METHODS: A survey of women in the immediate and later postpartum was conducted. Participants were 568 women at higher risk of anal sphincter damage, namely those who had an instrumental delivery and/or delivered a high birth weight infant (4000 g or more) at tertiary teaching hospitals in Australia. Women participated in a baseline hospital-based interview and a 12-month follow-up telephone interview. The main outcome measures were frank fecal incontinence (solid and/or liquid stool) and precursor symptoms (flatal incontinence, soiling, and/or fecal urgency) at 12 months postpartum. RESULTS: Prevalence rates were 2.6% for solid stool incontinence and 4.9% for liquid stool incontinence. Overall, 6.9% women had either one or both of these symptoms of frank fecal incontinence. Prevalence rates were 24.4% for flatal incontinence, 10.9% for soiling, and 14.8% for fecal urgency. Overall, 32.4% women had at least one of these precurser symptoms. Concurrent urinary incontinence and postpartum constipation were significantly associated with both frank fecal incontinence and precursor symptoms. In addition, joint hypermobility and older maternal age were associated with frank fecal incontinence, whereas inability to stop the urine flow and multiparity was associated with precursor symptoms. CONCLUSION: The present findings suggest that older and multiparous women, and women with joint hypermobility are at increased risk of postpartum anal incontinence symptoms after a high-risk delivery. Concurrent urinary incontinence, flow-stopping inability, and constipation are also associated with postpartum anal incontinence symptoms after high-risk deliveries.

Adolescent↗
PubMed2006

A prospective study of the effect of Neospora caninum and BVDV infections on bovine abortions in a dairy herd in Arequipa, Peru.

We used a prospective seroepidemiological approach to investigate endemic abortion in a dairy herd in Arequipa, Peru, and its association with Neospora caninum and bovine viral-diarrhoea virus (BVDV) infections. Between January 2002 and March 2004, 1094 pregnancies were confirmed in 538 cows. Of these, 137 pregnancies (13%) in 121 cows ended in abortion. The serological status to N. caninum was assessed using a single serological screening, whereas BVDV status was assessed at the herd level through consecutive samplings of young stock. Cox proportional-hazards models were used to estimate the effect of N. caninum and BVDV on the hazard of early (between day 42 and day 100 in gestation), and late (after day 100) abortions, respectively. Serological status to N. caninum was included as a dichotomous variable, and the effect of BVDV estimated at the herd level, as a time-dependent seasonal effect. Because data from repeated pregnancies were included, we considered possible lack of independence between observations and included frailty effects into the models. Our models also considered the possible confounding by parity and animal origin. Only multiparity was associated with the hazard of early abortion (HR=2.8 compared to nulliparous heifers). N. caninum seropositivity significantly affected the hazard of late abortion, but interacted with parity. The HRs for Neospora-positive animals were 6.4, 3.7 and 1.9, respectively, for nulliparous heifers, first-lactation cows and multiparous cows. Evidence of BVDV circulating (or not) among the young stock was not associated with abortions, but few cows in this herd were susceptible to incident infection.

Abortion, Veterinary↗
PubMed2004

Follicular dynamics and concentrations of steroids and gonadotropins in lactating cows and nulliparous heifers.

Differences in follicular development and circulating hormone concentrations, between lactating cows and nulliparous heifers, that may relate to differences in fertility between the groups, were examined. Multiparous, cyclic, lactating Holstein cows (n=19) and cyclic heifers (n=20) were examined in the winter, during one estrous cycle. The examinations included ultrasound monitoring and daily blood sampling. Distributions of two-wave and three-wave cycles were similar in the two groups: 79 and 21% in cows, 70 and 30% in heifers, respectively. Cycle lengths were shorter by 2.6 days in heifers than in cows, and in two-wave than in three-wave cycles. The ovulatory follicle was smaller in heifers than in cows (13.0+/-0.3 mm versus 16.5+/-0.05 mm). The greater numbers of large follicles in cows than in heifers corresponded well to the higher concentrations of FSH in cows. The duration of dominance of the ovulatory follicle tended to be longer in cows than in heifers. Estradiol concentrations around estrus and the preovulatory LH surge were higher in heifers than in cows (20 versus 9 ng/ml). Progesterone concentrations were higher in heifers than in cows from Day 3 to Day 16 of the cycle. Circulating progesterone did not differ between two-wave and three-wave cycles. The results revealed differences in ovarian follicular dynamics, and in plasma concentrations of steroids and gonadotropins; these may account for the differences in fertility between nulliparous heifers and multiparous lactating cows.

Animals↗
PubMed2005

Assessment of boar semen quality in relation to fertility with special reference to methanol stress.

The relationship between various semen evaluation tests and fertility in fertile and subfertile artificial insemination (AI) boars was examined. In total, 36 boars, 19 Finnish Landrace and 17 Yorkshire, were included. The average value of three ejaculates extended in an X-cell extender from each boar was used in the analysis. Based on nonreturn results (NR60d, later referred to nonreturn rate, NR%), the boars were divided into two groups: those with poor fertility (NR% < 80, n = 19) and those with normal or above average nonreturn rates (NR% = 83, n = 17). Semen quality was determined after 1 and 7 days of storage at 17 degrees C. Sperm motility before and after each methanol stress was assessed both subjectively and using a computer-assisted semen analyzer (CASA). The sperm cells were stained with calcein AM and propidium iodide and evaluated for plasma membrane integrity under an epifluorescence microscope. Propidium iodide and Hoechst 33258 dyes were used in parallel to stain sperm cells for fluorometric analysis with an automatic fluorometer. Sperm morphology was evaluated in stained smears. The percentage of sows reported as not having returned to estrus within 60 days after AI (nonreturn rate, NR%) and litter size of primiparous and multiparous farrowings were used as measures of fertility. Of the parameters analyzed, only CASA-assessed total sperm motility and methanol-stressed total sperm motility correlated significantly (P < 0.05) with nonreturn rate. Those tests presenting the highest correlation with nonreturn rate were CASA-assessed total motility (r = 0.54, P < 0.01) and subjective sperm motility (r = 0.52, P < 0.01) after 7 days of storage. The highest correlation with fertility at 1 day of storage was shown by methanol-stressed total sperm motility assessed with the CASA (r = 0.46, P < 0.01). The only semen parameter that correlated significantly (r = 0.37, P < 0.05) with litter size of multiparous farrowings was viability of seven-day stored semen stained with Hoechst 33258 and analyzed with a fluorometer. The methanol stress test described here could serve as a rapid test whose results could be used to predict NR% better than motility.

Animals↗
PubMed2005

Comparison of synchronization of ovulation with timed insemination and exogenous progesterone as therapeutic strategies for ovarian cysts in lactating dairy cows.

The objective of this study was to compare the effectiveness of the Ovsynch and controlled internal drug releasing (CIDR) protocols under commercial conditions for the treatment of cystic ovarian disease in dairy cattle. A total of 401 lactating dairy cows with ovarian cysts were alternatively allocated to two treatment groups on the day of diagnosis. Cows in the Ovsynch group were treated with GnRH on Day 0, PGF2alpha on Day 7, GnRH on Day 9, with timed insemination 16-20 h later. Cows in the CIDR group were treated with a CIDR insert on Day 0 for 7 days; on Day 7, the CIDR was removed, and cows were treated with PGF2alpha. All cows in the CIDR group were observed for estrus and cows exhibiting estrus within 7 days following removal of the CIDR and PGF2alpha administration were inseminated. The outcomes of interest for this experiment were the likelihood to be inseminated, return to cyclicity (determined by a CL on Day 21), conception and pregnancy rates. Data for these variables were analyzed using logistic regression. The percentage of cows inseminated in the Ovsynch and CIDR groups were 82 and 44%, respectively. Cows in the Ovsynch group were 5.8 times more likely to be inseminated than cows in the CIDR group. Cows with a low BCS were 0.48 times less likely to be inseminated than cows with a high BCS. The percentage of cows with a CL on Day 21 for the Ovsynch and CIDR groups was 83 and 79%, respectively (P > 0.05). Cows with a low BCS were 0.49 times less likely to have CL on Day 21 than cows with a high BCS. Conception and pregnancy rates for cows in the Ovsynch group were 18.3 and 14.4%, respectively. Conception and pregnancy rates for cows in the CIDR group were 23.1 and 9.5%, respectively. There was no significant differences between conception or pregnancy rates in cows in both groups. Primiparous cows were 2.6 times more likely to conceive than multiparous cows. In conclusion, the results of this study suggested that fertility was not different between cows with ovarian cysts treated with either the Ovsynch or the CIDR protocols in this dairy herd. In addition, primiparous cows had an increased likelihood for conception compared to multiparous cows, and cows with a low BCS were less likely to be inseminated or have a CL on Day 21, regardless of treatment.

Animals↗
PubMed2005

Screening for high fertility in high-producing dairy cows.

A retrospective study involving 2756 pregnancies from two commercial dairy herds in northeastern Spain determined relationships between management, production and reproductive data, and high fertility (conception before 90 days in milk) in high-producing dairy cows. High fertility was registered in 989 (35.9%) cows. The following data were recorded for each animal: herd, repeated animal (cows included two or more times within the study in which data were obtained from different lactational periods), parity (primiparous versus multiparous), previous twinning, reproductive disorders following calving (retained placenta, primary metritis) and at postpartum gynecological examination (incomplete uterine involution, pyometra and ovarian cysts), days in milk at conception, previous estrous synchronization and season of calving and conception. In order to evaluate the possible effect of high production during the peak milk yield on subsequent fertility, daily milk production at Day 50 postpartum was also recorded and cows were classified as high (> or = 50 kg) and low (< 50 kg) producers. Logistic regression analysis indicated no significant effects of herd, repeated animal, previous twinning, reproductive disorders such as primary metritis, incomplete uterine involution, pyometra and ovarian cysts, previous estrous synchronization and season of calving and insemination. Based on the odds ratio, the likelihood of high fertility increased in high-producer cows by a factor of 6.8. High fertility was less likely for multiparous cows (by a factor of 0.35) and for cows suffering placenta retention (by a factor of 0.65). High fertile cows produced a mean of 49.5 kg milk at Day 50 postpartum, in contrast to that 43.2 kg milk of the remainder cows. These findings question the negative effect of high production on fertility. Our results indicated that high individual cow milk production can be positively related to high fertility.

Animals↗
PubMed2006

Influence of the dam and sire on size at birth and subsequent growth, milk production and fertility in dairy heifers.

Genetic selection has resulted in larger cows with high milk production potential but a tendency for poor fertility. In multiparous cows fetal development competes for nutrients with concurrent milk production. This study tested the hypotheses that (a) maternal age and milk yield during pregnancy alter calf birth size and (b) birth weight influences subsequent productivity and fertility. Concurrently born Holstein-Friesian heifers (n=65) with multiparous dams and three sires were monitored from birth to the end of their first lactation to assess effects of birth weight on growth, milk production and fertility. Calves were analyzed as three subgroups: low (L), average (A) and high (H) birth weight (BW) calves (n=21-22 per group). LBW calves were born 10 kg lighter than HBW calves and remained significantly lighter throughout the study. They were generally smaller in other measured indices (length, height, girth, ponderal index) between birth and 9 months and were more likely to have older dams (lactations 3-6) with higher peak yields (>42 kg/day). Milk production parameters were indistinguishable between the 3 birthweight groups and metabolic parameters (IGF-I, insulin, glucose) measured around first calving were unaffected. HBW offspring were more likely to have persistent corpora lutea following their first calving and other fertility parameters also tended to be worse. Sire influenced gestation length but not birth size. Sire heritability estimates showed that weight, IGF-I and insulin concentrations after first calving and fertility in the first lactation were all heritable. The results support the hypothesis that high milk production in the dam may predispose to birth of a smaller calf. Smaller birth size did not, however, have any subsequent adverse effects on productivity or fertility in the first lactation and sire was more influential at this stage.

Animals↗
PubMed2005

Estradiol receptor-alpha expression in hypothalamic and limbic regions of ewes is influenced by physiological state and maternal experience.

The influence of estrus, pregnancy, parturition, and maternal experience on the expression of estrogen receptor-alpha (ERalpha) was investigated in hypothalamic and limbic regions of the sheep brain, using immunocytochemistry. Four days before parturition, previous maternal experience was associated with a higher density of ERalpha-labeled neurons in the paraventricular and supraoptic nuclei, the medial preoptic area, and the medial amygdala, but not in the mediobasal hypothalamus. Furthermore, an interaction was found between physiological state and experience in the peripartum period as the effect of experience existing 4 days prepartum was not found at parturition, when densities were lowest both in primiparous and in multiparous ewes. An additional effect of physiological state was also observed between parturition and estrus, densities being significantly lower at parturition than at estrus in the SON, PVN, and MPOA, but not in the medial amygdala. These results indicate that in sheep ERalpha expression is influenced by previous physiological and/or maternal experience at specific times of the reproductive cycle. They are also congruent with the higher ability of multiparous than nulliparous ewes to show maternal behavior several days prepartum.

Amygdala↗
PubMed2005

Reproductive experience differentially affects spatial reference and working memory performance in the mother.

The transition to motherhood results in a number of hormonal, neurological, and behavioral changes necessary to ensure offspring survival. Once motherhood is established, further neurological and behavioral changes may result with additional parity and mothering. Recent research has shown that motherhood enhances both hippocampal-dependent learning and memory and oxytocin-induced long-term potentiation, suggesting that the hippocampus is affected by mothering. In turn, degree of maternal behavior, either high or low, has been shown to affect spatial learning and memory performance in adult offspring. The present experiment aimed to investigate the effect of reproductive experience (nulli-, primi-, and multiparity and mothering) and degree of maternal behavior on hippocampus-dependent learning and memory in the mother. Results show that regardless of error type, primiparous rats make fewer errors compared to nulliparous rats, while multiparous rats show a trend towards making fewer errors compared to nulliparous rats. In addition, mothers who spend less time licking and nursing offspring had fewer reference memory errors. Perhaps the enhanced learning and memory in the inexperienced, new mother allows her to effectively acquire the suite of maternal behaviors necessary to ensure offspring survival and achieve reproductive success with subsequent reproductive experience.

Animals↗
PubMed1993

Emergency peripartum hysterectomy.

OBJECTIVES: By means of hospital-based data over 9 years we sought to evaluate the clinical indications and incidence of emergency peripartum hysterectomy by demographic characteristics and reproductive history. STUDY DESIGN: From the obstetric records of all deliveries at Brigham and Women's Hospital between Oct. 1, 1983, and July 31, 1991, we identified all women undergoing emergency peripartum hysterectomy, calculated crude and adjusted incidence rates, conducted statistical tests of linear trends and heterogeneity, and observed the clinical indications preceding the onset of this procedure. RESULTS: There were 117 cases of peripartum gravid hysterectomy identified during this period, for an overall annual incidence of 1.55 per 1000 deliveries. The rate increased with increasing parity and was significantly influenced by placenta previa and a history of cesarean section. The incidence by parity increased from one in 143 deliveries in nulliparous women with placenta previa to one in four deliveries in multiparous women with four or more deliveries with placenta previa. Likewise, the incidence increased from one in 143 deliveries in women with one prior live birth and a prior cesarean section to one in 14 deliveries in multiparous women with four or more deliveries with a history of a prior cesarean section. Both these trends were highly significant (p < 0.001). Abnormal adherent placentation was the most common cause preceding gravid hysterectomy (64%, p < 0.001), with uterine atony accounting for 21%. Although no maternal deaths occurred, maternal morbidity remained high, including postoperative infection in 58 (50%), intraoperative urologic injury in 10 patients (9%), and need for transfusion in 102 patients (87%). CONCLUSIONS: The data identify abnormal adherent placentation as the primary cause for gravid hysterectomy. The data also illustrate how the incidence of emergency peripartum hysterectomy increases significantly with increasing parity, especially when influenced by a current placenta previa or a prior cesarean section. Maternal morbidity remained high although no maternal deaths occurred.

Adult↗
PubMed1997

The value of elevated second-trimester beta-human chorionic gonadotropin in predicting development of preeclampsia.

OBJECTIVE: Our purpose was to investigate the association of an elevated second-trimester serum beta-human chorionic gonadotropin concentration with the subsequent development of hypertension in pregnancy and to evaluate its utility as a screening test for preeclampsia. STUDY DESIGN: We examined 6286 nondiabetic women with singleton pregnancies who, as part of triple-screen testing, had a serum beta human chorionic gonadotropin level drawn between 15 and 22 weeks' gestation between November 1, 1991, and November 30, 1994. Medical records of women with hypertension (n = 675) were reviewed, patients with chronic hypertension were excluded, and the remainder were classified as having gestational hypertension (n = 333), mild preeclampsia (n = 110), or severe preeclampsia (n = 84). The beta-human chorionic gonadotropin level expressed as multiples of the median adjusted for maternal weight and gestational age was compared between normotensive and hypertensive complicated pregnancies. RESULTS: In the overall population beta-human chorionic gonadotropin levels > or = 2.0 multiples of the median during the second trimester were significantly associated with development of hypertension in pregnancy. The rate ratio for development of overall hypertension was 1.6 (95% confidence interval 1.3 to 2.0) and for preeclampsia 1.8 (95% confidence interval 1.3 to 2.6). When stratified by parity, a statistically significant association remained only among multiparous women, for overall hypertension (rate ratio 2.2, 95% confidence interval 1.6 to 3.2) and for preeclampsia (rate ratio 3.4, 95% confidence interval 2.1 to 5.6). Adjusting for confounding factors did not alter the results. In the overall population, with the use of 2.0 multiples of the median of beta-human chorionic gonadotropin as a cutoff value, the sensitivity of beta-human chorionic gonadotropin as a screen for development of hypertension was 15.6%, the specificity was 90.0%, and the positive predictive value was 12.8%. CONCLUSION: Overall, second-trimester serum beta-human chorionic gonadotropin levels were elevated among women who had hypertension during pregnancy. In our population this association was statistically significant only among multiparous women. The utility of an elevated second-trimester beta-human chorionic gonadotropin level as a screening test for preeclampsia is limited.

Adult↗
PubMed1998

Second-trimester vaginal bleeding: correlation of ultrasonographic findings with perinatal outcome.

OBJECTIVE: Our purpose was to determine the relationship between ultrasonographic findings and perinatal outcome in patients with second-trimester vaginal bleeding. STUDY DESIGN: A retrospective case-control study was performed. One hundred sixty-seven patients with ultrasonographic examinations performed for bleeding between 13 and 26 weeks' gestation were identified through a comprehensive ultrasonography database. The main ultrasonographic findings of interest were the presence of an intrauterine clot, membrane separation, and placenta previa. A control group of 167 patients was obtained by selecting the next consecutive patient from the comprehensive perinatal database. Perinatal outcome measures for both groups were recorded. RESULTS: Multiparity was more common in patients with bleeding than in controls (69% vs 58%, p = 0.036), as was history of two or more previous preterm deliveries (6% vs none, p = 0.005). Second-trimester vaginal bleeding was associated with increased risk of preterm delivery (relative risk 1.9, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 6.3, 95% confidence interval 1.9 to 2.1), and perinatal death (relative risk 5.4, 95% confidence interval 2.1 to 13.7). The perinatal mortality rate was 162:1000 in these patients versus 30:1000 in controls. To assess the impact of ultrasonographic abnormalities, the study group was divided into two groups. Among the patients with second-trimester vaginal bleeding those with abnormal ultrasonographic findings had an increased risk of preterm delivery (relative risk 2.0, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 2.6, 95% confidence interval 1.1 to 6.3), perinatal death (relative risk 2.6, 95% confidence interval 1.3 to 5.3), and neonatal intensive care unit admissions (relative risk 3.2, 95% confidence interval 1.6 to 6.1). The perinatal mortality rate was 258:1000 for patients with abnormal ultrasonographic examinations. CONCLUSION: Second-trimester vaginal bleeding is more common in multiparous women and in women with a history of a previous preterm delivery. Perinatal morbidity and mortality is increased in patients with bleeding during the second trimester. The risk is compounded when abnormalities are detected by ultrasonography.

Adult↗