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PubMed2000

The influence of attitudes about unintended pregnancy on use of prenatal and postpartum care.

OBJECTIVE: The purpose of this study was to examine the effects of feelings about pregnancy and consideration of abortion on late initiation of prenatal care and postpartum appointment. STUDY DESIGN: A descriptive study was conducted in a tertiary clinic in Detroit using a convenience sample comprised of 518 low-income pregnant and postpartum women with a large number of unintended pregnancies. A series of chi-square analyses and logistic regression models were conducted to identify variables predictive of these outcomes. RESULTS: Teenagers were 1.8 times more likely to initiate late prenatal care versus early care (p = 0.05), and women who considered an abortion were 3.7 times more likely to initiate late prenatal care (p = 0.01). Having considered abortion but deciding against it due to psychologic/moral reasons was protective against late initiation of prenatal care (OR = 0.23; p = 0.01). Multiparity was the only predictor of a missed postpartum appointment. Multiparous women were three times more likely to miss the appointment (p = 0.05). CONCLUSIONS: Success in improving early access to prenatal care will involve addressing the issue of unintended pregnancy. This challenge will require that health care providers assess feelings and values related to a pregnancy. Understanding women's feelings and values about the pregnancy will allow providers to more effectively assist with decision-making and positive pregnancy behaviors. In addition, community-based education related to family planning and the value of prenatal and postpartum care is needed to involve women's partners, family, and friends, because social support systems influence decisions regarding pregnancy behaviors.

Abortion, Legal↗
PubMed2006

Maternal complications of pregnancy increase beyond 40 weeks of gestation in low-risk women.

OBJECTIVE: We sought to determine when rates of maternal pregnancy complications increase for low-risk nulliparous and multiparous women at term. METHODS: We designed a retrospective cohort study of low-risk women delivered beyond 37 weeks gestational age from 1976 to 2001. Rates of mode of delivery and maternal complications of labor and delivery were examined by gestational age with both bivariate and multivariate analyses. Statistical significance was designated by P<0.05. RESULTS: We found that among the 32,828 low-risk women who delivered at 37 completed weeks and beyond, the rates of primary cesarean delivery, operative vaginal delivery, third- or fourth-degree perineal lacerations, and chorioamnionitis all increased at 40 weeks of gestation (P<0.001), and the rate of postpartum hemorrhage increased at 41 weeks of gestation (P<0.001). These increases of rates of complications were larger and increased at an earlier gestational age among nulliparous women. CONCLUSION: We found that the risk of maternal complications for otherwise low risk nulliparous and multiparous women increased as pregnancy progressed beyond 40 weeks of gestation. Counseling of women who progress past their EDC should include comparing the risks of induction of labor to that of expectant management.

Adult↗
PubMed2004

MUC1 overexpression results in mammary gland tumorigenesis and prolonged alveolar differentiation.

MUC1 is a transmembrane mucin that was initially cloned from malignant mammary epithelial cells as a tumor antigen. More than 90% of human breast carcinomas overexpress MUC1. Numerous studies have demonstrated an interaction between MUC1 and other oncogenic proteins such as beta-catenin, erbB receptors and c-Src, but a functional role for MUC1 in transformation has not been identified. We previously reported the development of transgenic mice that overexpress human MUC1 in the mouse mammary gland (MMTV-MUC1). Analysis of these transgenic mice at an early age demonstrated the ability of MUC1 to potentiate EGF-dependent activation of MAP kinase signaling pathways in the lactating mammary gland. We now report that multiparous MMTV-MUC1 transgenic mice stochastically develop unifocal mammary gland carcinomas late in life. Molecular analysis of these tumors shows a tumor-specific coimmunoprecipitation between MUC1 and beta-catenin. Examination of the contralateral glands in MMTV-MUC1 transgenics demonstrates that the development of frank carcinomas is accompanied by a failure of multiparous glands to undergo postlactational involution. Furthermore, uniparous MMTV-MUC1 transgenic mice display decreased postlactational apoptosis, elevated whey acidic protein expression and aberrant pErk2 activation. These findings are the first to determine that MUC1 overexpression promotes in vivo transformation of the mammary gland.

Animals↗
PubMed2004

Parity-induced mammary epithelial cells facilitate tumorigenesis in MMTV-neu transgenic mice.

Using a Cre-lox-based genetic labeling technique, we have recently discovered a parity-induced mammary epithelial subtype that is abundant in nonlactating and nonpregnant, parous females. These mammary epithelial cells serve as alveolar progenitors in subsequent pregnancies, and transplantation studies revealed that they possess features of multipotent progenitors such as self-renewal and the capability to contribute to ductal and alveolar morphogenesis. Here, we report that these cells are the cellular targets for transformation in MMTV-neu transgenic mice that exhibit accelerated mammary tumorigenesis in multiparous animals. The selective ablation of this epithelial subtype reduces the onset of tumorigenesis in multiparous MMTV-neu transgenics. There is, however, experimental evidence to suggest that parity-induced mammary epithelial cells may not be the only cellular targets in other MMTV-promoter-based transgenic strains. In particular, the heterogeneous MMTV-wnt1 lesions predominantly express the ductal differentiation marker Nkcc1 that is absent in MMTV-neu-derived tumors. Our observations support the idea that tumors originate from distinctly different epithelial subtypes in selected MMTV-promoter-driven cancer models and that diverse oncogenes might exert discrete effects on particular mammary epithelial subtypes.

Animals↗
PubMed2005

Human Cripto-1 overexpression in the mouse mammary gland results in the development of hyperplasia and adenocarcinoma.

Human Cripto-1 (CR-1) is overexpressed in approximately 80% of human breast, colon and lung carcinomas. Mouse Cr-1 upregulation is also observed in a number of transgenic (Tg) mouse mammary tumors. To determine whether CR-1 can alter mammary gland development and/or may contribute to tumorigenesis in vivo, we have generated Tg mouse lines that express human CR-1 under the transcriptional control of the mouse mammary tumor virus (MMTV). Stable Tg MMTV/CR-1 FVB/N lines expressing different levels of CR-1 were analysed. Virgin female MMTV/CR-1 Tg mice exhibited enhanced ductal branching, dilated ducts, intraductal hyperplasia, hyperplastic alveolar nodules and condensation of the mammary stroma. Virgin aged MMTV/CR-1 Tg mice also possessed persistent end buds. In aged multiparous MMTV/CR-1 mice, the hyperplastic phenotype was most pronounced with multifocal hyperplasias. In the highest CR-1-expressing subline, G4, 38% (12/31) of the multiparous animals aged 12-20 months developed hyperplasias and approximately 33% (11/31) developed papillary adenocarcinomas. The long latency period suggests that additional genetic alterations are required to facilitate mammary tumor formation in conjunction with CR-1. This is the first in vivo study that shows hyperplasia and tumor growth in CR-1-overexpressing animals.

Adenocarcinoma↗
PubMed2006

Sustained trophism of the mammary gland is sufficient to accelerate and synchronize development of ErbB2/Neu-induced tumors.

Epidemiological studies indicate that parity enhances HER2/ErbB2/Neu-induced breast tumorigenesis. Furthermore, recent studies using multiparous, ErbB2/Neu-overexpressing mouse mammary tumor virus (MMTV-Neu) mice have shown that parity induces a population of cells that are targeted for ErbB2/Neu-induced transformation. Although parity accelerates mammary tumorigenesis, the pattern of tumor development in multiparous MMTV-Neu mice remains stochastic, suggesting that additional events are required for ErbB2/Neu to cause mammary tumors. Whether such events are genetic in nature or reflective of the dynamic hormonal control of the gland that occurs with pregnancy remains unclear. We postulated that young age at pregnancy initiation or chronic trophic maintenance of mammary epithelial cells might provide a cellular environment that significantly increases susceptibility to ErbB2/Neu-induced tumorigenesis. MMTV-Neu mice that were maintained pregnant or lactating beginning at 3 weeks of age demonstrated accelerated tumorigenesis, but this process was still stochastic, indicating that early pregnancy does not provide the requisite events of tumorigenesis. However, bitransgenic mice that were generated by breeding MMTV-Neu mice with a luteinizing hormone-overexpressing mouse model of ovarian hyperstimulation developed multifocal mammary tumors in an accelerated, synchronous manner compared to virgin MMTV-Neu animals. This synchrony of tumor development in the bitransgenic mice suggests that trophic maintenance of the mammary gland provides the additional events required for tumor formation and maintains the population of cells that are targeted by ErbB2/Neu for transformation. Both the synchrony of tumor appearance and the ability to characterize a window of commitment by ovariectomy/palpation studies permitted microarray analysis to evaluate changes in gene expression over a defined timeline that spans the progression from normal to preneoplastic mammary tissue. These approaches led to identification of several candidate genes whose expression changes in the mammary gland with commitment to ErbB2/Neu-induced tumorigenesis, suggesting that they may either be regulated by ErbB2/Neu and/or contribute to tumor formation.

Animals↗
PubMed1999

Smoking and blood pressure patterns in normotensive pregnant women.

This paper examines the relationship between smoking levels and blood pressure patterns of normotensive pregnant women in a prospective cohort of 2193 primiparous and 3176 multiparous, normotensive, Caucasian women selected from the Child Health and Development Studies in Oakland, California, 1959-67. Regression lines were fitted to each woman's blood pressure; mean intercept and slope estimates of the individual regressions were used to create summary profile lines for each smoking dose. Multivariable regression analysis controlled for maternal age, number of visits to the doctor after 20 weeks' gestation, body mass index and maternal education level. Overall, smokers had lower average diastolic blood pressure (smokers vs. nonsmokers adjusted mean: primiparas, 66.1 vs. 67.2 mmHg; and multiparas, 64.0 vs. 64.7 mmHg) but higher systolic blood pressure (smokers vs. nonsmokers adjusted mean: primiparas, 117.0 vs. 116.0; and multiparas, 112.5 vs. 110.0) than nonsmokers among primiparous and multiparous pregnant women after adjusting for potential confounders. However, these differences are small and there was no clear dose-response relationship between smoking level and blood pressure.

Adult↗
PubMed2002

An epidemiological study of childhood disability in Jeddah, Saudi Arabia.

Childhood disability is a major health problem that is pronounced in developing countries. The objectives of this study were to identify the maternal risk factors present in our society and their impact on acquiring a disabled child. Data were collected from the six governmental rehabilitation institutes and a sample of normal non-disabled school children in Jeddah City. Information on sociodemographic factors and maternal risk factors was collected by in-person interview and copied from the children's institute records. Logistic regression models were fitted to calculate the adjusted odds ratios in order to demonstrate the impact for the various maternal risk factors on having a disabled child. Our results have shown that certain modifiable maternal risk factors affecting child health still exist in our community, such as early and late-age marriage and childbearing, as well as low education, unemployment, multiparity and consanguineous marriages. All these risks were shown to put the mother at higher risk of having an auditory disabled child. Also, older-age childbearing (> or = 30 years), low education level and multiparity were the maternal risk factors identified that influenced the risk of visual disability in children. Similar maternal risk factors, in addition to unemployment, were more observed among mothers of mentally disabled children. A huge effort is required to discourage the potential risk factors in our community that influence child health.

Adolescent↗
PubMed2002

Socially marketed insecticide-treated nets improve malaria and anaemia in pregnancy in southern Tanzania.

OBJECTIVES: To study the uptake of socially marketed insecticide-treated nets (ITNs) and their impact on malaria and anaemia in pregnancy; and to report on a discount voucher system which aimed to increase coverage in pregnancy. METHODS: A 12-month cross-sectional study of women in the second or third trimester of pregnancy. ITN use and other factors were assessed by questionnaire and a blood sample taken for malaria parasitaemia and anaemia. 'Non-users' of ITNs included both women not using any net and women using untreated nets. RESULTS: Fifty three per cent of pregnant women used ITNs. Women aged 15-19, primigravidae, unmarried women, and those with no access to cash had the lowest ITN use. Fewer ITN users were positive for malaria than ITN non-users (25 vs. 33%: P=0.06), and the protective efficacy (PE) for parasitaemia was 23% (CI 2-41). Multiparous ITN users had a twofold decrease in parasite density compared with multiparous non-ITN users (625 parasites/microl vs. 1173 parasited/microl: P=0.01). Fewer ITN users were anaemic (Hb < 11 g/dl) than ITN non-users (72 vs. 82%: P=0.01). ITNs had a PE of 12% (CI 2-21) against mild anaemia and a PE of 38% (CI 4-60) against severe anaemia (Hb < 8 g/dl). There was a trend in the prevalence of severe, mild and no anaemia, and of high density, low density and no malaria infection by ITN status. Recently treated nets were most effective at preventing malaria and anaemia (prevalence of mild anaemia was 68% compared with 82% for those without nets (P=0.002); prevalence of malaria was 22% compared with 33% for those without nets (P=0.02). Knowledge and reported use of the discount voucher system were low. Further qualitative research is ongoing. CONCLUSIONS: A modest impact of ITNs on pregnancy malaria and anaemia was shown in our high malaria transmission setting. The development of ITN programmes for malaria control should include pregnant women as a specific target group.

Adolescent↗
PubMed2001

Epidemiology of gallstone disease in Chandigarh: a community-based study.

BACKGROUND: Cholelithiasis is frequent in our country (India), and is a common cause for abdominal surgery. We studied the prevalence of gallstone disease and its association with various risk factors in the city of Chandigarh. METHODS: A house-to-house survey of residents aged 15 years or above in a subsector of Chandigarh was conducted as a part of a pilot survey. All individuals with a history of gallstone disease, and equal or more number of asymptomatic individuals were asked to attend the outpatient department of the Postgraduate Medical Institute. On the basis of the pilot survey, the sample size to be studied was 2648 and we screened 2649 persons. RESULTS: Two hundred and fifty-four individuals attended the outpatient services of the Institute, and 248 underwent an ultrasound. There were 37 symptomatic and 211 asymptomatic individuals (male: female, 93:155). Gallstone disease was seen in 24 out of 37 (64.9%) in the symptomatic, and seven out of 211 (3.3%) in the asymptomatic group. Out of these, 27 females and four males had gallstone disease (mean age: 48.30 +/- 16.03 years). Approximately 67% of patients were between 20 and 60 years of age. Gallstone disease was more frequently seen in those from high socioeconomic status as compared to middle socioeconomic status (chi2 = 8.9, d.f. = 1, P < 0.01), and in multiparous as compared to nulliparous females (chi2 = 4.8, d.f. = 1, P < 0.05). Body mass index, smoking, alcohol consumption, and a vegetarian/non-vegetarian diet did not influence the prevalence of gallstone disease. CONCLUSIONS: Gallstone disease is frequent in northern India. Gallstones were frequent in those belonging to high socioeconomic status and multiparous females. However, body mass index, smoking, alcohol or other dietary habits did not make a difference.

Adolescent↗
PubMed2004

Intrapartum ultrasound estimation of total bladder volume.

OBJECTIVE: To determine whether real-time ultrasound measurement of multiple linear dimensions of the bladder could be used to estimate total bladder volumes of women in labour. AIM: To create a simple reproducible formula using ultrasound techniques to help estimate total bladder volumes of women in labour. This may prevent unnecessary catheterisation and conversely, avoid failure to catheterise when indicated, thereby reducing the complications associated with catheterisation and bladder overdistension. DESIGN: Prospective, observational study of women in labour. SETTING: Delivery Suite, Obstetric Hospital, University College London Hospitals. POPULATION: Forty-nine women in labour recommended for catheterisation by their attending midwives. METHOD: A real-time ultrasound scanner was used to measure bladder diameters in two planes: transverse width and height, and sagittal width and height. A Foley's catheter was inserted and the bladder drained into a graduated bowl under sterile conditions. These values and urine volumes were recorded and a formula for detecting bladder volumes above 300 mL was developed using linear regression methods and the Bland-Altman limits of agreement. MAIN OUTCOME MEASURE: Sensitivity and specificity of derived formulae in predicting bladder volume from ultrasound measurements. Correctly predicted volumes greater than 300 mL. RESULTS: Among the 49 women, 36 were nulliparous and 13 were multiparous. All had full-term pregnancies with cephalic presentation and were in active labour with cervical dilatations ranging from 3 to 10 cm. There were no previous caesarean sections among the multiparous women. Thirty-nine women had epidural analgesia. Indications for catheterisation included a palpable bladder per abdomen, or the interval from last urine voided. The catheterised volumes ranged from 30 to 720 mL with a median of 150 mL. The new equation (0.68 x h x d x w) had a sensitivity of 77% (95% CI 46-95%) and specificity of 86% (95% CI 71-95%) for detecting bladder volumes greater than 300 mL. In order to ensure that about 95% of women in need of catheterisation are detected, the above equation was improved using the Bland-Altman limits of agreement. The sensitivity of this final equation (1.74 x h x d x w) was 100% (95% CI 75-100%) and the specificity dropped to 36% (95% CI 21-54%). CONCLUSION: It is possible to use real-time ultrasound in estimation of total bladder volumes of women in labour. The implications are that all of those normally selected as being in need of catheterisation could be detected, while about a quarter of those women would avoid unnecessary catheterisation.

Catheterization↗
PubMed2001

Platelet transfusion refractoriness associated with HPA-1a (Pl(A1)) alloantibody without coexistent HLA antibodies successfully treated with antigen-negative platelet transfusions.

BACKGROUND: Alloimmune-mediated refractoriness to platelet transfusion is most commonly due to antibody to HLA antigens in multiply transfused or multiparous patients. Published reports of poor transfusion response due to antibodies to platelet-specific antigens are rare and often confounded by the presence of coexistent antibodies against HLA antigens. CASE REPORT: A case is presented of a multiparous woman with acute myelogenous leukemia whose sole cause of transfusion refractoriness was antibody to platelet antigen HPA-1a. She responded dramatically to HPA-1a-negative platelet transfusion. CONCLUSION: This case provides strong serologic and clinical evidence that platelet transfusion refractoriness may result from antibodies to platelet-specific antigens.

Antigens, Human Platelet↗
PubMed2004

Analysis of macrophage presence in murine placenta: influence of age and parity status.

PROBLEM: Beneficial effects of multiparity status have been previously reported by different authors. However, this fact has not been fully explained. Taking into consideration the influence of the parity status on the in vitro asymmetric/protective antibodies and the fact that interleukin-6 (IL-6) is involved in the production and immune-regulatory functions of placental macrophages, the aim of this work was to compare the placental IL-6 production and tissue macrophage presence in mice with different age and parity status. METHOD OF STUDY: Three groups of mice (CBA/J x CBA/J) were analyzed: primiparous young (PY: 3.0 +/- 0.5 months old), primiparous old (PO: 8.5 +/- 0.5 months old), and multiparous old (MO: 8.5 +/- 0.5 months old, with three to four previous pregnancies). Macrophage and IL-6 were identified in placental tissue by immunohistochemistry employing anti-F4/80 or anti-IL-6 antibodies. IL-6 secretion was analyzed in the placental culture supernatants by enzyme-linked immunosorbent assay. RESULTS: The results obtained indicate that, despite the level of macrophages observed in the PO placentae was higher than in PY ones, their expression in MO placentae was very much increased, appearing like a thick layer between decidua and trophoblast. However, no significant difference was found among the groups in the tissue expression of IL-6 and in IL-6 secreted in vitro. CONCLUSIONS: Our data indicate that parity status influences the number of local macrophages and might provide evidence that could explain the known beneficial effect of multipaternity. We suggest that the number of previous pregnancies favor the production of a 'protective' population of macrophages.

Aging↗
PubMedDate not supplied

Comparison of an oestrus synchronisation protocol with oestradiol benzoate and PGF2alpha and insemination at detected oestrus to a timed insemination protocol (Ovsynch) on reproductive performance of lactating dairy cows.

A total of 226 out of 245 postpartum lactating dairy cows in a commercial dairy farm were allocated to two groups of oestrous synchronisation protocols in order to evaluate reproductive performance. One group was treated with oestradiol benzoate (ODB) and PGF2alpha on day 10 of the oestrous cycle with insemination at the detected oestrus, the second group underwent the Ovsynch (OVS) protocol (GnRH + PGF2alpha + GnRH) with timed AI. Pregnancy was diagnosed by ultrasonography on day 28 after AI and confirmed by rectal palpation on day 45. A higher (P < 0.001) proportion of cows in OVS (100%) were inseminated within (19.2 +/- 3.8 h) following the second GnRH injection than those of cows in EPE (ODB + PGF2alpha + ODB) (70.6%) inseminated at the detected oestrus within (35.6 +/- 5.2 h) following the second ODB injection. Pregnancy rates for the first AI at day 28 (64.0 +/- 4.6, 62.4 +/- 5.5%) and at day 45 post-insemination (40.4 +/- 4.7, 40.0 +/- 5.6%) for OVS and EPE cows respectively, did not differ between the two treatments, whereas, the overall pregnancy rates tended to be higher (P < 0.08) for the OVS (85.1 +/- 3.8%) cows than the EPE cows (74.1 +/- 4.5%). No differences were observed in pregnancy rates for first AI and overall up to fourth AI between primiparous (34.7 +/- 5.8 and 85.3 +/- 4.7%) and multiparous cows (43.5 +/- 4.5 and 77.4 +/- 3.6%). Days open for pregnant cows tended to be lower (P < 0.08) for OVS (76.2 +/- 3) than for EPE cows (84.7 +/- 4), while days open were higher (P < 0.05) in primiparous cows (85.3 +/- 4) than in multiparous cows (75.6 +/- 3). The results indicate that pregnancy rates for first AI were similar, but overall pregnancy rates up to the fourth AI tended to be higher for OVS than EPE cows, while days open was tended to be lower for OVS than EPE cows.

Animals↗
PubMed2001

HPV co-factors related to the development of cervical cancer: results from a population-based study in Costa Rica.

We examined factors associated with high-grade squamous intraepithelial lesions (HSIL) and cervical cancer among human papillomavirus (HPV)-infected women in a prevalent case-control study conducted within a population-based cohort of 10 077 women in Costa Rica. We compared 146 women with HPV-positive HSIL or cancer (HSIL/CA) against 843 HPV-positive women without evidence of HSIL/CA. Subjects completed a risk factor questionnaire. We evaluated the associations between exposures and HSIL/CA among women positive for any HPV and restricted to those positive for high-risk HPV types. Risk of HSIL/CA increased with increasing number of live births (P(trend)= 0.04). Women who smoked 6+ cigarettes/day had a RR for HSIL/CA of 2.7 (95% CI = 1.1-6.7) compared to non-smokers. Current use of barrier contraceptives was associated with a reduction in risk of HSIL/CA (RR = 0.39; 95% CI = 0.16-0.96). Sexual behaviour and a self-reported history of sexually transmitted diseases (STDs) other than HPV were not associated with HSIL/CA. Oral contraceptive use was associated with HSIL/CA among women with <3 pregnancies. Effects were similar in analysis restricted to women positive for high-risk HPV types. Among women positive for high-risk HPV types, 44% of HSIL/CA could be attributed to multiparity (>/=3 pregnancies) and/or smoking. Among HPV-positive women, multiparity and smoking are risk factors for HSIL/CA. Oral contraceptive use may be associated with HSIL/CA in subgroups of women.

Adolescent↗
PubMed1993

Anal-sphincter disruption during vaginal delivery.

BACKGROUND: Lacerations of the anal sphincter or injury to sphincter innervation during childbirth are major causes of fecal incontinence, but the incidence and importance of occult sphincter damage during routine vaginal delivery are unknown. We sought to determine the incidence of damage to the anal sphincter and the relation of injury to symptoms, anorectal physiologic function, and the mode of delivery. METHODS: We studied 202 consecutive women six weeks before delivery, 150 of them six weeks after delivery, and 32 with abnormal findings six months after delivery. Symptoms of anal incontinence and fecal urgency were assessed, and anal endosonography, manometry, perineometry, and measurement of the terminal motor latency of the pudendal nerves were performed. RESULTS: Ten of the 79 primiparous women (13 percent) and 11 of the 48 multiparous women (23 percent) who delivered vaginally had anal incontinence or fecal urgency when studied six weeks after delivery. Twenty-eight of the 79 primiparous women (35 percent) had a sphincter defect on endosonography at six weeks; the defect persisted in all 22 women studied at six months. Of the 48 multiparous women, 19 (40 percent) had a sphincter defect before delivery and 21 (44 percent) afterward. None of the 23 women who underwent cesarean section had a new sphincter defect after delivery. Eight of the 10 women who underwent forceps delivery had sphincter defects, but none of the 5 women who underwent vacuum extractions had such defects. Internal-sphincter defects were associated with a significantly lower mean (+/- SD) resting anal pressure (61 +/- 11 vs. 48 +/- 10 mm Hg, P < 0.001) six weeks post partum, and external-sphincter defects were associated with a significantly lower squeeze pressure (increase above resting pressure, 70 +/- 38 vs. 44 +/- 13 mm Hg; P < 0.001). There was a strong association (P < 0.001) between sphincter defects and the development of bowel symptoms. CONCLUSIONS: Occult sphincter defects are common after vaginal delivery, especially forceps delivery, and are often associated with disturbance of bowel function.

Adolescent↗
PubMed2000

Effect of external cephalic version at term on fetal circulation.

OBJECTIVE: We sought to investigate the subclinical effect of external cephalic version on fetal circulation. STUDY DESIGN: A prospective observational study was conducted on 136 subjects who had external cephalic version at or beyond 36 weeks of gestation without clinical complication. Doppler ultrasonographic studies of the umbilical and middle cerebral circulations were performed before and after the external cephalic version. The following Doppler indexes were measured: (1) the pulsatility index of the umbilical artery, which represents disturbance of placental circulation, and (2) the pulsatility index of the fetal middle cerebral artery, which represents fetal response. The Wilcoxon signed rank test was used for all statistical analyses. RESULTS: There was no significant difference in pulsatility index of the umbilical artery before and after external cephalic version (P =.674). There was a statistically significant reduction in the pulsatility index of the middle cerebral artery after external cephalic version (P =.043), and this difference existed only among multiparous women (P =.029), among those in whom the external cephalic version was considered to be difficult (P =.038), and when the placenta was posteriorly located (P =.028). The reduction in pulsatility index was not related to whether the external cephalic version was successful. In all cases the Doppler indexes remained within the normal ranges, and there were no associated fetal complications. CONCLUSION: External cephalic version was not associated with any significant disturbance of placental resistance to blood flow. Conversely, external cephalic version was associated with a significant reduction in the pulsatility index of the middle cerebral circulation, especially among the multiparous women, after a difficult procedure or in those with a posterior placenta. This probably represents a normal fetal physiologic response to manipulation of the fetal head.

Bradycardia↗
PubMed2000

Maternal and neonatal outcomes after induction of labor without an identified indication.

OBJECTIVE: This study was undertaken to examine associations between induction of labor and maternal and neonatal outcomes among women without an identified indication for induction. STUDY DESIGN: This was a population-based cohort study of 2886 women with induced labor and 9648 women with spontaneous labor who were delivered at 37 to 41 weeks' gestation, all without identified medical and obstetric indications for induction. RESULTS: Among nulliparous women 19% of women with induced labor versus 10% of those with spontaneous labor underwent cesarean delivery (adjusted relative risk, 1.77; 95% confidence interval, 1.50-2.08). No association was seen in multiparous women (relative risk, 1.07; 95% confidence interval, 0. 81-1.39). Among all women induction was associated with modest increases in instrumental delivery (19% vs 15%; relative risk, 1.20; 95% confidence interval, 1.09-1.32) and shoulder dystocia (3.0% vs 1. 7%; relative risk, 1.32; 95% confidence interval, 1.02-1.69). CONCLUSION: Among women who lacked an identified indication for induction of labor, induction was associated with increased likelihood of cesarean delivery for nulliparous but not multiparous women and with modest increases in the risk of instrumental delivery and shoulder dystocia for all women.

Adult↗