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PubMed1999

A randomized comparison of oral misoprostol versus Foley catheter and oxytocin for induction of labor at term.

OBJECTIVE: We sought to compare the efficacy and safety of oral misoprostol administered to patients with the efficacy and safety in a control group treated with a Foley catheter and oxytocin for induction of labor. STUDY DESIGN: Two hundred patients requiring induction of labor at term with a Bishop score of </=5 were randomized to receive oral misoprostol or a cervical Foley catheter plus oxytocin. Patients in the misoprostol group received 50 microg at 4-hour intervals for a maximum of 6 doses or until an adequate contraction pattern developed. Those in the control group had a Foley catheter inserted in the cervix, whereas oxytocin was administered intravenously by a standard incremental infusion protocol to a maximum dose of 36 mU/min. RESULTS: In multiparous patients the percentage delivered of their neonates within 24 hours and the median induction-to-delivery times were similar in the 2 groups. In nulliparous patients, however, delivery within 24 hours was significantly less likely in the misoprostol group (53.4% vs 82. 5%; P <.001), and the median induction-to-delivery time was longer (23.3 hours vs 17.2 hours; P <.01). There were no differences in the incidence of meconium, chorioamnionitis, low Apgar scores, or cesarean delivery. The incidence of hyperstimulation was higher in the oxytocin-Foley group (4.1% vs 13.1%; P =.02). CONCLUSION: Oral misoprostol is as effective as oxytocin-Foley catheter for inducing labor in multiparous women. Misoprostol appears less efficacious in nulliparous patients.

Administration, Oral↗
PubMed1999

Lipoprotein metabolism during normal pregnancy.

OBJECTIVE: We sought to investigate the changes in circulating serum lipids and lipoproteins, including lipoprotein (a), and low-density lipoprotein size in women during normal pregnancy. STUDY DESIGN: Twenty-two women (mean age, 31 +/- 5 years; 13 primiparous subjects) were studied during uncomplicated pregnancy with normal outcome. Twenty-four nulliparous women of similar age (31 +/- 4 years) were studied as control subjects. RESULTS: Serum triglycerides and total and low-density lipoprotein cholesterol increased significantly during pregnancy in all women. Women with changes in low-density lipoprotein during the second and third trimesters showed a more marked increase in serum triglycerides, and this effect was slightly more evident in the multiparous subjects. No other differences were evident between primiparous and multiparous women apart from high-density lipoprotein cholesterol levels, which were slightly decreased in the latter subjects. CONCLUSIONS: Our results show that during normal pregnancy, the increase in plasma triglycerides may lead to the appearance of the atherogenic dense low-density lipoproteins in a subgroup of women. We suggest that the observed changes in low-density lipoprotein patterns during pregnancy might be used to identify those women who later in life will have these atherogenic small and dense low-density lipoproteins.

Adult↗
PubMed1999

Development of hyperplasias, preneoplasias, and mammary tumors in MMTV-c-erbB-2 and MMTV-TGFalpha transgenic rats.

Human cDNAs corresponding to two epidermal growth factor-related products that are overexpressed in human breast cancers, that for c-erbB-2 (HER-2) and for transforming growth factor alpha (TGFalpha), have been cloned downstream of the mouse mammary tumor virus (MMTV) long terminal repeat promoter and injected into the pronucleus of fertilized oocytes of Sprague-Dawley rats to produce transgenic offspring. Expression of the transgenic mRNAs is not detectable in mammary tissue from virgin transgenic rats but is detected in mammary tissue from certain lines of mid-pregnant transgenic rats. When two such lines of either type of transgenic rat are subjected to repeated cycles of pregnancy and lactation, they produce, primarily in the mammary glands, extensive pathologies, whereas virgin transgenic rats produce no such abnormalities. Multiparous transgenic female offspring from c-erbB-2-expressing lines develop a variety of focal hyperplastic and benign lesions that resemble lesions commonly found in human breasts. These lesions include lobular and ductal hyperplasia, fibroadenoma, cystic expansions, and papillary adenomas. More malignant lesions, including ductal carcinoma in situ and carcinoma, also develop stochastically at low frequency. The mammary glands of transgenic females invariably fail to involute fully after lactation. Similar phenotypes are observed in female MMTV-TGFalpha transgenic rats. In addition, multiparous TGFalpha-expressing female transgenics frequently develop severe pregnancy-dependent lactating hyperplasias as well as residual lobules of hyperplastic secretory epithelium and genuine lactating adenomas after weaning. These transgenic rat models confirm the conclusions reached in transgenic mice that overexpression of the c-erbB-2 and TGFalpha genes predisposes the mammary gland to stochastic tumor development.

Animals↗
PubMed1998

Variation in the appearance of the normal sacroiliac joint on pelvic CT.

OBJECTIVE: To describe the CT appearance of the ageing sacroiliac joints (SJ) and correlate the radiological findings with patients' gender, body mass index (BMI) and, in women, parity. MATERIALS AND METHODS: The study population included 288 consecutive patients who underwent pelvic CT for various indications not related to SJ diseases. Patients were stratified by age, BMI and parity in women. The joint space and subchondral sclerosis were assessed and the presence of osteophytes, ankylosis, erosions, subchondral cysts and vacuum phenomena were noted on bone window settings. RESULTS: The widths of the SJ space and of the subchondral sclerosis on the iliac and sacral sides were 2.3+/-0.4mm, 2.5+/-1.6mm and 1.4+/-0.5mm, respectively, in patients younger than 40 years of age and 1.9+/-0.2 mm, 3.6+/-2.1 mm and 2.3+/-1.1 mm, respectively, in patients older than 40 years of age. The joint space tends to become narrow and less uniform with advancing age, while subchondral sclerosis appeared to be wider and less uniform in the elderly. Osteophytes were present even in younger patients and their prevalence increased with advancing age. Ankylosis and erosions were rare findings, observed only after the fifth decade of life. A higher prevalence of asymmetric non-uniform SJ space, ill-defined, non-uniform, extensive subchondral sclerosis and ankylosis was observed in women, obese and multiparous mothers than the age matched men, normal weighted individuals and non-multiparous women, respectively. CONCLUSION: Conventional pelvic CT can provide valuable information concerning the SJ, when reviewed on bone window settings. The CT appearance of the SJ is closely related to patients age, gender, BMI and, in women, parity. Knowledge of the spectrum of radiological findings observed in the normal population may be useful when interpreting examinations of patients with SJ disease.

Adolescent↗
PubMed1999

Mathematical relationships between uterine contractions, cervical dilatation, descent and rotation in spontaneous vertex deliveries.

OBJECTIVE: To determine the mathematical relationships between the strength and duration of the uterine contractions, the descent and rotation of the fetal head and the degree of cervical dilatation in 50 multiparous women with spontaneous vaginal deliveries using a simple device applied to the fetal vertex. METHOD: A simple device for monitoring the progress of labor was applied to the fetal vertex. The device allows the continuous monitoring of descent and rotation of the fetal head. The amount of descent and the degree of rotation were also determined by repeated vaginal examinations as well as the degree of cervical dilatation. The frequency of uterine contractions was also recorded on a partogram. RESULT: A good correlation was found between the amount of descent of the fetal vertex (r = 0.975) and between the degree of rotation of the fetal head (0.83) determined by both methods. Multiple regression analysis was then performed and the degree of cervical dilatation in cm at any given time during the first stage of labor was found to be equal to 2.859 + 0.583 fetal head station in (cm) + 0.1983 internal rotation in degrees -0.0493 (station x internal rotation) + 0.1599 station2 + 0.3622 uterine contractions per 10 min. A nomogram was constructed allowing the calculation of cervical dilatation for a given station of the head, degree of rotation and frequency of uterine contractions. CONCLUSION: There is a defined mathematical relationship between the degree of descent and rotation of the fetal head, the degree of cervical dilatation and the frequency of uterine contractions in multiparous women with vertex presentation. The first three variables can be continuously determined by using the described device. Incorporation of the device into a reusable fetal scalp electrode allows the dual mechanical and electronic monitoring during labor with minimal vaginal examinations.

Cervix Uteri↗
PubMed1997

The vesico-urethral pressuregram analysis of urethral function under stress.

About one-third of older multiparous women are prone to stress urinary incontinence (SUI): unwanted urine loss during activities which suddenly raise intra-abdominal pressure. In this paper we describe and test a method for visualizing and analyzing the function of the urinary continence control system (CCS) under stress. Intravesical and intraurethral pressure changes from the resting state were recorded at proximal, mid-, and distal urethral locations during increasingly severe coughs and cross-plotted on a 'vesico-urethral pressuregram.' The slope (alpha) and intercept (chi zero) resulting from a linear regression analysis of these data were used to develop a continence equation which can be used to predict the equilibrium point pressure (PE): the intravesical pressure at which urine will leak to the intraurethral pressure recording site. We tested the null hypothesis that these parameters would not differ in six young, nulliparous continent women (mean +/- S.D. age: 30 +/- 3.5 yr) and six multiparous SUI women (52.3 +/- 8.0 yr, parity: 1.7 +/- 0.8), or between urethral locations. Significant differences in continence equation parameters were found between groups and in different urethral locations. In the SUI group static factors calculated from the term (1 - alpha) contributed 27% of the mean (S.D.) midurethral PE value, 145 (46) cm H2O, while dynamic factors, estimated from alpha, contributed 73% of this value. Valuable insights for improving the diagnosis and treatment of SUI may be obtained by analyzing the relative contributions of alpha and chi 0 to urethral closure during physical stress.

Adult↗
PubMed2001

Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study.

OBJECTIVE: To investigate the association between parity and urinary incontinence, including subtypes and severity of incontinence, in an unselected sample, with special emphasis on age as a confounder or effect modifier. METHODS: This was a cross-sectional study (response rate 80%) with 27,900 participating women. Data on parity and urinary leakage, type, frequency, amount, and impact of incontinence were recorded by means of a questionnaire. A validated severity index was used. Relative risks (RR) with nulliparous women as reference were used as an effect measure. RESULTS: Incontinence was reported by 25% of participants. Prevalences among nulliparous women ranged from 8% to 32%, increasing with age. Parity was associated with incontinence, and the first delivery was the most significant. The association was strongest in the age group 20-34 years with RR 2.2 (95% confidence interval [CI] 1.8, 2.6) for primiparous women and 3.3 (2.4, 4.4) for grand multiparous women. A weaker association was found in the age group 35-64 years (RRs between 1.4 and 2.0), whereas no association was found among women over 65 years. For stress incontinence in the age group 20-34 years, the RR was 2.7 (2.0, 3.5) for primiparous women and 4.0 (2.5, 6.4) for grand multiparous women. There was an association with parity also for mixed incontinence, but not for urge incontinence. Severity was not clinically significantly associated with parity. CONCLUSION: Parity is an important risk factor for female urinary incontinence in fertile and peri- and early postmenopausal ages. Only stress and mixed types of incontinence are associated with parity. All effects of parity seem to disappear in older age.

Adult↗
PubMed2002

The likelihood of placenta previa with greater number of cesarean deliveries and higher parity.

OBJECTIVE: To examine the relationship between prior cesarean delivery and placenta previa. METHODS: A hospital-based, case-control study was conducted in which 316 multiparous women with placenta previa were identified. Controls consisted of 2051 multiparous women with spontaneous vaginal deliveries. Information on prior cesarean delivery was examined in three forms: as a dichotomous variable, as an ordinal variable, and as a set of three indicator variables for one, two, and three or more cesarean deliveries. Multivariable logistic regression modeling was used to obtain an adjusted estimate of this association. RESULTS: Women with a prior cesarean delivery were more likely to have a placenta previa than those without (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.21, 2.08). The likelihood of placenta previa increased as both parity and number of cesarean deliveries increased. Thus, the adjusted OR for a primiparous woman with one cesarean delivery was 1.28 (95% CI 0.82, 1.99). For a woman who has four or more deliveries with only a single cesarean delivery, the OR increases to 1.72 (95% CI 1.12, 2.64). This trend continues with greater parity and a greater number of cesarean deliveries such that the likelihood of placenta previa for a woman with parity greater than four and greater than four cesarean deliveries was OR 8.76 (95% CI 1.58, 48.53). CONCLUSION: This study supports the association between prior cesarean delivery and placenta previa and demonstrates that the joint effect of parity and prior cesarean delivery is greater than that of either variable alone.

Adult↗
PubMed2003

Impact of labor induction, gestational age, and maternal age on cesarean delivery rates.

OBJECTIVE: To quantify the impact of labor induction and maternal age on cesarean delivery rates in nulliparous and multiparous women between 36 and 42 weeks' gestation. METHODS: We performed a retrospective cohort study on 14,409 women delivering at two teaching hospitals in metropolitan Boston during 1998 and 1999. Women who had contraindications to labor, including a prior cesarean delivery, were excluded. The risks for cesarean delivery by induction status, gestational age by completed week between 36 and 42 weeks, maternal age <35, 35-39, and >/=40 years, and stratified by parity, were calculated by logistic regression. RESULTS: In nulliparas, labor induction was associated with an increase in cesarean delivery from 13.7% to 24.7% (adjusted odds ratio [OR] 1.70; 95% confidence interval [CI] 1.48, 1.95]). In multiparas, induction was associated with an increase from 2.4% to 4.5% (OR 1.49; 95% CI 1.10, 2.00). Other variables that placed a nulliparous woman at increased risk for cesarean delivery included maternal age of at least 35 years and gestational ages over 40 weeks. For multiparas, only maternal age 40 years or older and gestational age of 41 weeks were associated with an increase in cesarean deliveries. CONCLUSION: Induction of labor, older maternal age, and gestational age over 40 weeks each independently increase the risk for cesarean delivery in both nulliparous and multiparous women. Although the relative risk from induction is similar in nulliparas and multiparas, the absolute magnitude of the increase is much greater in nulliparas (11% versus 2.1%).

Adult↗
PubMed1997

Case-control study of risk factors for complicated eclampsia.

OBJECTIVE: To identify risk factors associated with complicated eclampsia. METHODS: Twenty-four patients with eclampsia complicated by intracerebral hemorrhage, pulmonary edema, renal, hepatic, or respiratory failure, disseminated intravascular coagulation, abruptio placentae, pulmonary aspiration, or hemolysis, elevated liver enzymes, low platelets syndrome were compared retrospectively with 101 uncomplicated eclamptic controls. Information on maternal demographic factors, medical and obstetric histories, and maternal and perinatal outcomes was retrieved and analyzed by univariate and multivariate analysis. RESULTS: By multiple logistic regression, the only risk factors associated with the development of complicated eclampsia were maternal age over 26 years (adjusted odds ratio [OR] 6.3, 95% confidence interval [CI] 2.17, 18.48), multiparity (adjusted OR 4.5, 95% CI 1.55, 13.60) and no prenatal care (adjusted OR 3.3, 95% CI 1.25, 9.60). CONCLUSION: Maternal age above 26 years, multiparity, and no prenatal care are the maternal risk factors identified for the development of complicated eclampsia.

Adult↗
PubMed1998

A retrospective analysis of factors contributing to calf mortality and dystocia in beef cattle.

Records of 2191 calvings from the Clemson University Beef Physiology Unit between 1981 and 1993 were analyzed to determine factors affecting malpresentation, mortality and dystocia. Only 20 (0.91%) parturitions involved malpresentation: posterior presentation (n = 14), leg deviations (n = 3), head deviations (n = 2) and breech birth (n = 1). Dystocia affected calf mortality within 24 h of birth (P < 0.05), with mortality increasing as the severity of dystocia increased. There was an overall 4.5% death loss within 24 h of birth, with 4 and 7% mortality rates for calves from multiparous and primiparous dams, respectively (P < 0.05). Mortality was higher for bull vs heifer calves (P < 0.05). Ninety-four percent of calvings were unassisted, while 6% were assisted births. Dystocia was greater (P < 0.01) in primiparous (17%) than in multiparous dams (4%). In births involving dystocia, 28.1% required mild traction, 69.3% required heavy traction and 2.6% required Cesarean section. Birth weights associated with normal births and mild traction (36 and 36 kg) were lighter than those associated with heavy traction and Cesarean section (40 and 42 kg, respectively; P < 0.05). In conclusion, malpresentations were too few to be of significance, and dystocia influenced mortality within 24 h of birth. Calf birth weight and parity of dam explained most of the observed variations in dystocia.

Age Factors↗
PubMed1999

Mother rats bar-press for pups: effects of lesions of the mpoa and limbic sites on maternal behavior and operant responding for pup-reinforcement.

This series of studies explored the operant response rates for pup-reinforcement of female Sprague Dawley rats that were either postpartum or cycling and sustained lesions of the medial preoptic area (mpoa), the lateral amygdala, the nucleus accumbens, or sham lesions. The last experiment tested the effects on operant responding of preventing direct access to pups in mpoa and sham-lesioned postpartum mothers. All animals were trained prior to mating on an FR-1 bar-press schedule to criterion (50 presses in 30 min) for a food (Froot Loops) reward in an operant chamber. At the end of pregnancy animals that were to be tested postpartum were provided in their home cages with six newborn foster pups; mother-litter interactions were observed on the last 3 days of pregnancy and throughout the postpartum period. On each of these same days after a period of separation from pups, females were tested in the operant box for delivery of rat pups. With each bar-press response, a rat pup rather than a Fruit Loop was delivered down a gentle shoot into the hopper. Non-postpartum, but maternal, multiparous animals who were showing estrous cycles were tested using the same procedures. The first and second studies showed that animals (both postpartum and as cycling multiparous animals) with mpoa lesions exhibited a significant reduction in bar-press rate for pup reinforcement in the operant box. In postpartum animals, amygdala lesions also produced a bar-press deficit, whereas nucleus accumbens lesions did not. All lesioned groups showed deficits in maternal responding in the home cage and deficits in retrieval in the operant box. These results indicate that systems associated with the mpoa mediate both the stereotypical maternal behaviors and pup-reinforcement. In contrast, the expression of home cage maternal behavior is dependent on the integrity of both the amygdala and nucleus accumbens, whereas operant responding need not be. These results indicate a dissociation of mechanisms mediating expression of the species-typical maternal behavior and pup-reinforcement.

Amygdala↗
PubMed2000

Mother rats bar-press for pups: effects of lesions of the mpoa and limbic sites on maternal behavior and operant responding for pup-reinforcement.

This series of studies explored the operant response rates for pup-reinforcement of female Sprague Dawley rats that were either postpartum or cycling and sustained lesions of the medial preoptic area (mpoa), the lateral amygdala, the nucleus accumbens, or sham lesions. The last experiment tested the effects on operant responding of preventing direct access to pups in mpoa and sham-lesioned postpartum mothers. All animals were trained prior to mating on an FR-1 bar-press schedule to criterion (50 presses in 30 min) for a food (Froot Loops) reward in an operant chamber. At the end of pregnancy animals that were to be tested postpartum were provided in their home cages with six newborn foster pups; mother-litter interactions were observed on the last 3 days of pregnancy and throughout the postpartum period. On each of these same days after a period of separation from pups, females were tested in the operant box for delivery of rat pups. With each bar-press response, a rat pup rather than a Fruit Loop was delivered down a gentle shoot into the hopper. Non-postpartum, but maternal, multiparous animals who were showing estrous cycles were tested using the same procedures. The first and second studies showed that animals (both postpartum and as cycling multiparous animals) with mpoa lesions exhibited a significant reduction in bar-press rate for pup reinforcement in the operant box. In postpartum animals, amygdala lesions also produced a bar-press deficit, whereas nucleus accumbens lesions did not. All lesioned groups showed deficits in maternal responding in the home cage and deficits in retrieval in the operant box. These results indicate that systems associated with the mpoa mediate both the stereotypical maternal behaviors and pup-reinforcement. In contrast, the expression of home cage maternal behavior is dependent on the integrity of both the amygdala and nucleus accumbens, whereas operant responding need not be. These results indicate a dissociation of mechanisms mediating expression of the species-typical maternal behavior and pup-reinforcement.

Amygdala↗
PubMed2001

Clinical, provider and sociodemographic determinants of the number of antenatal visits in England and Wales.

The objective of this study was to measure the independent effects of clinical factors and non-clinical factors, such as provider and sociodemographic characteristics, on the number of antenatal visits made by women in England and Wales. The study was based on a survey of the secondary case records of 20,771 women with singleton pregnancies who were delivered between 1 August 1994 and 31 July 1995. The women in the survey attended one of nine maternity units in Northern England and North Wales selected within those areas to reflect geographical variations, as well as variations in the size and teaching status of the institution. A multivariate Poisson regression model was developed to examine differences in the number of antenatal visits made by women with different clinical and non-clinical characteristics. After controlling for non-clinical factors, primiparous women identified as high risk at booking made 1.0% more visits than primiparous women identified as low risk at booking (p = 0.196). Multiparous women identified as high risk at booking made 3.5% more visits than their low risk counterparts (p<0.001). High risk-defining criteria during antenatal care led to a 0.3% weekly increase in the number of antenatal visits amongst primiparous women (p <0.001) and a 0.4% weekly increase in the number of antenatal visits amongst multiparous women (p < 0.001). Several notable results, not reported elsewhere in the literature, were revealed by the regression analyses. After all independent variables were controlled for, women who were booked into urban teaching hospitals made 10% fewer antenatal visits than the women who were booked into the urban non-teaching hospitals. Women of Pakistani origin made 9.1% fewer antenatal visits than women of white British origin. Similar results were revealed for women of Indian origin and women from other ethnic groups. Non-smokers made 6.0% more antenatal visits than smokers. The planned pattern of antenatal care, number of carers seen, gestation at first presentation and maternal age also had significant independent impacts on the number of antenatal visits. The study highlights the sizeable impact of non-clinical factors on the antenatal care delivery process and indicates ways in which variations in antenatal care might be reduced.

Adult↗
PubMed2003

Decreased levels of fibrinogen in very high parity women.

OBJECTIVES: To evaluate coagulation parameters in healthy pregnant grand grand multiparous women. STUDY DESIGN: Prothrombin time (PT), activated partial thromboplastin time (PTT), fibrinogen, D-dimer, albumin and blood lipids were prospectively determined in 50 pregnant grand grand multiparas (> or =9 deliveries) and 50 age-matched pregnant women with low parity (< or =3 deliveries). RESULTS: The average concentrations of fibrinogen in the grand grand multiparas were 4.0+/-0.6 as compared to 4.7+/-0.7 g/l in the control group (P<0.001). In both groups D-dimer levels were >1000 ng/ml and the concentrations of albumin, triglycerides, cholesterol, high-density lipoprotein (HDL) were not significantly different. CONCLUSIONS: In healthy pregnant grand grand multiparous women fibrinogen levels are lower than in age-matched women with low parity. These changes are not directly associated with lipids metabolism during pregnancy.

Adult↗
PubMed2003

Umbilical cord length and parity--the Greek experience.

OBJECTIVES: To investigate the relationship between parity and cord length, with respect to peripartum characteristics. STUDY DESIGN: Parity, cord length, placental and birth weight were the studied variables in a sample of 534 parturients with singleton fetuses. Parturients were divided into four groups: primiparous (para-1), secundiparous (para-2), tetriparous (para-3) and multiparous (para >3). Oneway ANOVA and post-hoc tests were applied for the comparison of mean cord length between the four groups of parity. General Linear Model was applied for the detection of covariates. RESULTS: ANOVA yielded significant differences between the four groups. Mean cord length was significantly higher in women of parity >or=3 than in women with lower parity. Although both placental and birth weight were correlated with cord length, application of GLM showed that only birth weight could act as a covariate for the length differences between parity groups. CONCLUSIONS: Cord length appears to increase with advancing parity, the cut-off point being between the second and the third labor. We suggest that intrapartum monitoring should be performed in all multiparous parturients, because of their propensity for longer cords, and thus for related complications.

Birth Weight↗
PubMed1999

Risk factors for pelvic endometriosis in women with pelvic pain or infertility. Gruppo Italiano per lo Studio dell' endometriosi.

OBJECTIVE: The objective of the study was to analyse the relationship between selected characteristics and risk of pelvic endometriosis. STUDY DESIGN: Eligible for the study were 817 women with primary or secondary infertility or pelvic pain requiring laparoscopy. Of these, 393 were included for infertility and 424 for pelvic pain. RESULTS: A total of 345 (42.2%) had a diagnosis of endometriosis and 472 did not have the disease. Multiparous women had endometriosis less frequently than nulliparous, the estimated odds ratios (OR) were respectively 0.9 (95% confidence interval, CI, 0.5-1.6) and 0.4 (95% CI 0.2-0.7) in women reporting one and two or more births. In comparison with women reporting no spontaneous abortion, the estimated OR was 0.3 (95% CI 0.2-0.5) in those who reported > or =1 miscarriage. In comparison with women reporting menstrual cycles lasting > or =25 days subjects with totally irregular menstrual cycles had a reduced risk of endometriosis (OR 0.6, 95% CI 0.3-0.9). No significant association emerged between smoking, age at menarche and risk of endometriosis. CONCLUSIONS: this study confirms, with a different methodological approach to previously published studies, that multiparity, a history of abortion and lifelong irregular menstrual pattern decrease the risk of endometriosis in women with pelvic pain and infertility.

Adult↗
PubMed2000

Maternal serum levels of macrophage colony-stimulating factor are associated with adverse pregnancy outcome.

OBJECTIVE: The aim of this study was the measurement of maternal serum levels of M-CSF throughout pregnancy, in a low risk obstetrical population, to examine the relationship of M-CSF and pregnancy outcome. STUDY DESIGN: Maternal serum was obtained at various stages of pregnancy and post partum, M-CSF levels were measured by ELISA, pertinent clinical data tabulated, and pregnancy outcome was determined. RESULTS: In 564 pregnancies studied, 22% of 260 nulliparous pregnancies and 10% of 304 multiparous pregnancies were hypertensive. Preeclampsia occurred in 1.5% of nulliparous and in 1% of the multiparous women. In apparently normal pregnancies with good outcome, M-CSF levels rose throughout pregnancy. No cases of preeclampsia occurred if maternal serum M-CSF levels increased more than 100% throughout pregnancy. CONCLUSIONS: This study suggests that absolute levels and relative changes in maternal serum M-CSF levels during pregnancy are associated with adverse pregnancy outcomes.

Birth Weight↗