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The paper describes the obstetric management of an unique case of twin, bicorial, biamniotic pregnancy in which the second twin born 36 days after the first. Both twins are living today.
This study evaluated the influence of prior perinatal factors on birth weight, length of gestation, and maternal pregravid and postpartum weights in subsequent pregnancies. The study sample included 47 women each with first, second and third pregnancies. Mean pregravid weight increased by 5.2 lb between the first and second pregnancies and by 4.4 lb between the second and third pregnancies. Total weight gain averaged 31 lb for the first pregnancy and 28.4 and 28.3 lb for the second and third pregnancies, respectively. Mean birth weight increased by 111 g between the first and second pregnancies and by 199 g between the second and third pregnancies. Mean gestational age was similar for all three pregnancies, averaging 39.5 weeks. Using stepwise forward multiple regression analyses, we determined that birth weight and length of gestation are both influenced significantly by prior birth weight and length of gestation; subsequent pregravid weight is influenced significantly by prior rate of gain, pregravid weight and postpartum weight; and postpartum weight is significantly influenced by prior rate of gain and birth weight. Comparisons across three pregnancies for the same woman showed that differences in birth-to-conception interval were not associated with higher postpartum weight or subsequent pregravid weight. These data indicate that in healthy, nonsmoking, low-risk women, the maternal and infant outcomes of pregnancies are significantly influenced by prior outcomes but not by either short birth-to-conception interval or greater maternal age.
The incidence of higher-order gestations is increasing primarily as a result of menstrual cycle manipulation, with concomitant increased risk in maternal and fetal complications. Perinatal mortality rates range between 47 and 120 per 1000 births for twins and 93 to 203 per 1000 births for triplets. The critical period of perinatal mortality and morbidity is between weeks 23 and 28 of gestation. Attention has recently turned to methods of delaying the birth of second and higher order fetuses to improve newborn survival and decrease neonatal morbidity in these high-risk pregnancies. We report two cases of delayed interval delivery. Neither pregnancy involved a monochorionic/monoamniotic gestation. The first case was a twin gestation delivered at 21 weeks with an interval of 5 days and extreme prematurity of both twins. The second case was a triplet gestation delivered at 21 weeks with an interval of 5 days. Triplet A was stillborn; triplets B and C succumbed in extreme prematurity. Preterm labor in multiple gestations usually results in delivery of all fetuses. On occasion, the uterus will spontaneously cease to contract after the birth of one or more premature infants. Review of the literature now reports 48 twin pregnancies exposed to delayed interval delivery with 40 surviving infants of 96 fetuses. Whereas delaying the delivery of remaining fetuses improves their prognosis, there is currently no consensus regarding technique nor is there statistical significance in techniques currently used. Furthermore, study is indicated to reduce preterm birth and associated costs.
Studies have shown that perinatal factors are associated with childhood asthma. The current analyses examined the association between obstetric complications and risk of asthma at the age of 7 years using a prospectively population-based birth cohort in northern Finland. Results indicated that obstetric complications were associated with a higher risk of asthma among children. Those children who were administered special procedures at birth, i.e., cesarean section, vacuum extraction, and other procedures, including use of forceps, manual auxiliary, and extraction breech, had an adjusted odds ratio (OR) for asthma of 1.38 (95% confidence interval [CI] 1.00-1.92), 1.32 (95% CI 0.80-2.19), and 2.14 (95% CI 1.06-4.33), respectively, as compared to children who were delivered normally. Children who had a lower Apgar score at the first and the fifth minute after birth also had a higher risk as compared to those who had an Apgar score of 9-10. The results encourage further evaluation of the association between obstetric complications and risk of asthma among children in other populations, and further exploration of possible mechanisms underlying the association.
Epidemiologic studies have been inconsistent in suggesting an association between abortion and breast cancer risk. Whether the protection provided by a full-term pregnancy also results from a short-term pregnancy or whether a prematurely terminated pregnancy could increase the risk of breast cancer is unclear. Data from a large, international collaborative study were used to evaluate the association between abortions, whether spontaneous or induced, and breast cancer risk. The data from seven countries included 3,958 breast cancer cases and 11,538 hospital controls with information on abortion history obtained through interviews. Compared with nulliparous women with no abortion (baseline), the odds ratios (OR) and 95 percent confidence intervals (CI) were: for nulliparous women with a history of prior abortion, 0.86 (CI = 0.68-1.08); for parous women with no history of abortion, 0.63 (CI = 0.57-0.69); for parous women with abortion before first birth, 0.82 (CI = 0.69-0.97); and, for parous women with abortion only after first birth, 0.70 (CI = 0.63-0.79). When restricting analysis to parous women, those with a history of abortion exhibited an elevated OR suggesting a 29 percent risk increase if the incomplete pregnancy occurred before first birth (CI = 1.16-1.36) and an 11 percent risk increase for abortion only after first birth (CI = 1.02-1.20) compared with women without such history. The associations observed were stronger among the youngest women. These results do not support a large overall association between abortion and breast cancer risk.
Longitudinal studies of physical development in the first year of life were carried out in the group of children born with low body weight. Results were compared with those obtained in the control group. The examined group consisted of 73 children born from single pregnancies in hospitals from families living in Wola district of Warsaw. Out of 73 children, 35 were born t term as small-for-date children (DW). Remaining 38 children were prematurely born (W). The control group (K) consisted of 40 children born in hospital at term, from single pregnancy, with body-weight at birth corresponding to foetal age (25-75 centiles). They came also from families living in Wola district. Analysis of physical development was based on the results of anthropometric measurements carried out at monthly intervals through the first year of life, considering required age tolerance, using standardized measuring methods and instruments. The principles of feeding, nursing, prophylaxis of rickets and iron deficiency as well as preventive vaccinations were the same for all children. Variability with age as well as monthly and yearly gains and the index of sexual dimorphism of the following parameters were analysed: body-weight, body-length, head and chest circumference thorax and head length, shoulders width, hip width. Longitudinal observation of these children through evaluation of growth increments made the analysis of the dynamics of somatic development possible. The analysis showed differences in physical development in the first year of life in children under examination. These differences concerned both the variability of separate traits with age, and the dynamics of development, development of sexual dimorphism index in relation to the control group. The differences ere also observed between the small-to-date and prematurely born children. Developmental differences ere noted among the children born with low body-weight dependent on the achieved foetal age at birth. No tendency in small-for-date infants to decrease the differences as compared to the control group was noted. This tendency was typical of the prematurely born children. The highest developmental rate was observed in prematurely born infants.(ABSTRACT TRUNCATED AT 400 WORDS)
The present prospective study carried out in 1993 in the SFH "Maĭchin Dom"--Sofia, includes newborn infants with birth weight below 2500 g. and aims to compare the effect of the prophylaxis of the haemorrhagic disease of the newborn by intramuscular and peroral application of vit. K. For this purpose some coagulation screening tests were followed out in intervals of 4-5 days during the first two weeks of life. These two groups are compared between one another and with non-prophylacted with vit. K healthy newborn babies. The results so obtained allow to make the conclusion that, on one side, the haemostasis of newborns with low birth weight is very labile and, on another, that the peroral and the intramuscular ways of prophylaxis with vit. K have the same effectiveness.
During the fieldwork on illness in children in an Aymara peasant community in Southern Peru, data was collected on child mortality. In 35 families surveyed in the village, the total child mortality rate was estimated diachronically at 380 per 1,000 live births. The majority of the child death in these families occurred in the first days after birth. These deaths were also counted as perinatal deaths, and thus the perinatal mortality rate was found to be high as well at 252 per 1,000 total births (99% confidence interval: 181-330 per 1,000). Congenital malformations incompatible with life, neonatal tetanus, and other neonatal disorders did not have an especially high frequency in the village. These disorders seem to explain only a part of the early neonatal deaths responsible for the high mortality rates in children. As perinatal deaths were concentrated in 13 of the 35 families in the survey (especially in those families with many total births and at least two living children), the possibility of infanticide was put forward to explain the high death rates in children in the first days of life. This hypothesis was supported by practices in the village concerning the baptism of dead children by which the cause of death was left unsanctioned. Infanticide could be important to curb recent and future population growth and the resulting pressure on the land.
To investigate the hypothesis that neonates who receive intramuscular vitamin K are at an increased risk of developing cancer, particularly leukaemia, a pooled analysis of individual patient data from six case-control studies conducted in Great Britain and Germany has been undertaken. Subjects comprised 2431 case children diagnosed with cancer before 15 years of age and 6338 control children. The retrospective assessment of whether or not an individual baby received vitamin K is not straightforward. In many cases no record was found in stored medical notes and two types of analysis were therefore conducted; in the first it was assumed that where no written record of vitamin K was found it had not been given, and in the second, where no written record of administration was found, information on hospital policy and perinatal morbidity was used to 'impute' whether or not vitamin K had been given. In the first analysis, no association was found between neonatal administration of intramuscular. vitamin K and childhood cancer: odds ratios adjusted for mode of delivery, admission to special care baby unit and low birth weight were 1.09 (95% confidence interval 0.92-1.28) for leukaemia and 1.05 (0.92-1.20) for other cancers. In the second analysis, the adjusted odds ratios increased to 1.21 (1.02-1.44) for leukaemia and 1.10 (0.95-1.26) for other cancers. This shift did not occur in all studies, and when data from the hypothesis generating Bristol study were excluded, the adjusted odds ratios for leukaemia became 1.06 (0.89-1.25) in the first analysis and 1.16 (0.97-1.39) when data on prophylaxis imputed from hospital policy and perinatal morbidity were used. We conclude that whilst the broad nature of the diagnostic groups and the poor quality of some of the vitamin K data mean that small effects cannot be entirely ruled out, our analysis provides no convincing evidence that intramuscular vitamin K is associated with childhood leukaemia.
To study the effects of body position (supine versus prone) on changes in cardiac inter-beat interval during quiet and active sleep, 6-h continuous electrocardiographic recordings and simultaneous minute-by-minute behavioural activity state assignments were made in 61 healthy, growing, low birthweight infants. The infants weighed 795-1600 g at birth and ranged between 30-38 wk in postconceptual age. Infants were randomly assigned to the supine or prone position for the first 3 h of each study; the position was reversed for the second 3 h. Higher heart rates and lower time and frequency domain measures of inter-beat interval variability were observed in the prone position as compared to the supine position, during both quiet and active sleep. In addition, an analysis of consecutive increases and decreases in the instantaneous heart rate revealed a lower incidence of sustained accelerations or decelerations in the prone position. Although consistent findings concerning inter-beat interval variability and sleeping position were obtained from all analytic techniques, the differences derived from analysis of consecutive inter-beat changes were the most robust. These differences in multiple measures of cardiac rate and rhythm between prone and supine positions suggest that autonomic control of the heart is altered by body position, the net effect on heart rate being increased sympathetic dominance.
Using data collected as part of the hospital-based World Health Organization (WHO) Collaborative Study of Neoplasia and Steroid Contraceptives, the authors examined potential risk factors for sarcoma of the uterus. Twenty-nine patients with uterine sarcoma who were between 15 and 56 years of age and diagnosed at one of nine centers were matched on age and center to 198 controls selected from hospital admissions to other than obstetric and gynecologic wards. All women were interviewed regarding their medical and reproductive history, methods of birth control, and history of sexual relationships and of sexually transmitted infections. The risk of uterine sarcoma was lower in parous women compared to nulliparous women (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.1, 3.3), and the risk decreased with increasing number of live births. A greater proportion of cases than controls reported giving birth to their first child at the age of 25 or later, even after adjustment for parity (OR = 3.5; 95% CI = 1.2, 10.9). Cases were also more likely than controls to report a history of a spontaneous abortion (OR = 2.5; 95% CI = 0.8, 7.4) or an induced abortion (OR = 1.6; 95% CI = 0.4, 6.3). Late menarche and early menopause were both positively associated with the risk of uterine sarcoma. No association was observed with a history of infertility, use of oral contraceptives, or measures of sexual activity. The findings with respect to childbearing and menstrual history differ from those of a recent cohort study, and indicate the need for larger investigations to assess the role of these and other risk factors in the occurrence of sarcomas of the uterus.
Controversy exists over the possible relationship between induced and spontaneous abortion and risk of breast cancer. Thus, the association of fatal breast cancer and spontaneous abortion was examined in a large prospective study of United States adult women. After seven years of follow-up, 1,247 cases of fatal breast cancer were observed among 579,274 women who were cancer-free at interview in 1982 and who provided complete reproductive histories. Results from Cox proportional hazards models, adjusted for other risk factors, showed no association between a history of spontaneous abortion and risk of fatal breast cancer (rate ratio [RR] = 0.89, 95 percent confidence interval [CI] = 0.78-1.02). The RR did not increase with increasing numbers of abortions. Parous women who had a spontaneous abortion before their first term birth were not at increased risk compared with parous women with no history of spontaneous abortion (RR = 0.76, CI = 0.54-1.05). Women whose only pregnancy ended in a spontaneous abortion were not at increased risk compared with women who were never pregnant (RR = 0.61, CI = 0.27-1.38) or whose only pregnancy ended in a livebirth (RR = 0.72, CI = 0.32-1.65). These findings do not support an association between spontaneous abortion and fatal breast cancer.
Development of the barrel field in layer IV of SI cortex of neonatal rats was studied in vivo using electrophysiological recording techniques. This study was designed to determine (a) the earliest time SI cortex is responsive to peripheral mechanical and/or electrical stimulation and (b) whether the development of the SI cortical barrel field map of the body surface follows a differential pattern of development similar to the pattern previously demonstrated using peanut agglutinin (PNA) binding (McCandlish et al. 1989). Carbon fiber microelectrodes were used to record evoked responses from within the depth of the cortex in neonatal rats between postnatal day 1. (PND-1), defined as the day of birth, and PND-14. Evoked responses were first recorded approximately 12 h after birth. These responses in the youngest animals were of low amplitude, monophasic waveshape, and long latency, with long interstimulus intervals necessary to drive the cortex. Increases in amplitude and complexity of waveshape and decreases in latency were observed over subsequent postnatal days. The earliest responses recorded on middle PND-1 were evoked by stimulation of the face and/or mystacial vibrissae. The next responses were evoked approximately 24 h after birth (late PND-1) by stimulation of the forelimb. The last responses were evoked approximately 36 h after birth (middle PND-2), by stimulation of the hindlimb. The physiological map of the representation of the body surface follows a developmental gradient similar to the gradient observed using PNA histochemistry; however, the lectin-generated morphological map lagged approximately 48 h behind the physiological map.(ABSTRACT TRUNCATED AT 250 WORDS)
Data collected on N'Dama cattle from a Government Station at Yundum, The Gambia were analysed for a range of performance traits recorded during the period 1970 to 1985. Least squares procedures were employed to evaluate the influence of environmental and genetic effects on reproductive and productive performance traits. Mean age (n = 59) and weight (n = 87) at first calving were 48.2 +/- 7.6 (s.d.) months and 235 +/- 35 kg respectively and were significantly (P less than 0.05) affected by year of birth. Calving intervals averaged 634 +/- 32 days (n = 160) but their distribution showed three peaks; 12, 24 and 33 months. Previous year of calving had a significant effect on calving interval (P less than 0.01). Calf mean liveweights at birth, one, three and six months and at weaning (eight months) were 20.1 +/- 3.7, 30.7 +/- 6.0, 51.1 +/- 13.2, 88.9 +/- 25.0 and 110.5 +/- 27.0 kg, respectively. Calf mean daily weight gains to weaning averaged 0.38 +/- 0.14 kg. Liveweights and growth rates were significantly influenced by year of birth (P less than 0.01) and sex of calf (P less than 0.05). Cow mean liveweights at calving and six months after parturition were 272.3 +/- 43.0 and 277.4 +/- 34.2 kg. Calf mortality from birth to weaning was 4.6%. Productivity indices based on an eight-month weaner calf per cow per year, per 100 kg cow per year and per 100 kg of metabolic weight of cow per year were 82.6 +/- 36.5, 30.5 +/- 11.9 and 138.2 +/- 55.4 kg respectively. These levels of productivity were equal or superior to those obtained for N'Dama cattle in similar management situations elsewhere in West Africa and to those of a larger breed under a ranch situation in East Africa.
Serum GH, IGF-I, IGF-II and IGFBP-2 concentrations were determined by radioimmunoassay in swine of genetic lines which were selected for high (obese) and low (lean) backfat. Blood samples were collected at birth, before and after nursing, at 1 and 3 days of age and at weekly or fortnightly intervals until 30 weeks of age. Overall, GH, IGF-I, IGF-II and IGFBP-2 were highest at birth and declined during the first week of postnatal life. An age-by-line interaction was apparent for GH and IGF-I during the early neonatal period with levels being higher in the lean line than the obese line at 1 day of age and similar at 1 week of age. At 3 to 5 weeks of age there was an elevation in GH which was greater in lean than obese pigs. IGFBP-2 concentration patterns were characterized by a nadir at 5 to 7 weeks of age and a decline from an apex at 8 weeks of age in both lines. IGF-II declined steadily from birth until about 10 weeks of age. A subsequent increase in IGF-II was then observed between 12 and 22 weeks, which was greater in the obese line and in male pigs but not apparent in lean females. At birth, pigs which had not nursed had higher GH and IGFBP-2 and lower IGF-I and IGF-II concentrations. The effect of nursing on IGF-I was significantly influenced by line.(ABSTRACT TRUNCATED AT 250 WORDS)
During a recent 36-month interval, all neonates of less than or equal to 1250 gram birth weight who were admitted to our Newborn Special Care Unit and survived the first 36 postnatal hours underwent either computed tomography or echoencephalography or both for the assessment of neonatal germinal matrix hemorrhage and intraventricular hemorrhage. Seventy of the 164 long-term surviving infants experienced neonatal germinal matrix and/or intraventricular hemorrhage (GMH/IVH Group), whereas 94 infants had studies that were negative (Non-hemorrhage Group). Serial neurodevelopmental assessments were performed on 142 (87%) of the 164 long-term surviving infants; these assessments included the Bayley Scales of Infant Development at 3, 6, 12, and 18 months (corrected age) and the Stanford-Binet and Peabody Picture Vocabulary examinations at 30 months (corrected age). At 30 months (corrected age), the incidence of major neurologic abnormalities was extremely low in both the GMH/IVH and the Non-hemorrhage groups. In addition, although there were few survivors of the more severe grades of intraventricular hemorrhage, we could detect no difference between the developmental scores of the GMH/IVH and the Non-hemorrhage Group infants.
OBJECTIVE: To describe an alternative method of vaginal birth to the conventional assisted delivery for extremely preterm breech infants within intact amnions, and to compare the immediate neonatal outcomes with those delivered by cesarean. METHODS: Retrospective review of singleton breech deliveries under 26 weeks' gestation after spontaneous labor with intact membranes. Nine "en caul" vaginal births after tocolysis and six cesarean deliveries performed for the sole indication of preterm labor were identified between 1996 and 2001. RESULTS: The vaginal group's mean gestation and cervical dilatation on admission were 23(+6) weeks and 3.2 cm, respectively, and 24(+6) weeks and 2.8 cm in the cesarean group. Vaginal delivery occurred an average of 4 days after admission and 1 day for cesarean delivery. Mean time interval between the first corticosteroid injection and delivery was greater in the vaginal group (90 versus 22 hours). Failure to start or complete a steroid course was more likely in the operative group (67% versus 11%). Mean birth weights were comparable. Five-minute Apgar scores and cord pHs were 6 and 7.41, respectively, for vaginal births, and 5.5 and 7.32 after cesarean deliveries. Fifty-five percent of vaginally delivered infants had a 5-minute Apgar score less than 7, with 22% of the whole group dying during the first week of life. This compared with 66% and 50%, respectively, for cesarean infants. Of the survivors, average age at discharge was 121 days for both groups. CONCLUSION: Vaginal birth can be effected in extremely preterm breech pregnancies with intact membranes by adopting the "en caul" delivery method.
The objective of this study was to determine the effect of soy-based diets on mammary tumors in female cancer- prone mice. Transgenic virgin female mice expressing human pituitary growth hormone and their respective phenotypically normal littermates were fed a diet containing either casein (C), low-isoflavone soy protein (LIS), or high-isoflavone soy protein (HIS). Indices of tumor development were measured throughout the study. Both days from birth until death and days on diet until death were increased [by 20% (P = .01) and 19% (P = .02), respectively] in the LIS group when compared with the C group. Both intervals were increased also (by 16% and 17%, respectively; P < .05) in the HIS group when compared with the C group. Days from birth to first tumor were increased by 7% (P < .05), as was days on diet to first tumor by 5% (P < .05), in the LIS group when compared with the C group. First-onset number of tumors was decreased (P = .02) by 41% and 34% in the LIS and C groups, respectively, when compared with the HIS group. Final onset of tumors was decreased (P < .05) by 44% and 9% in the LIS and HIS groups, respectively, when compared with the C group. Total area of final tumors was decreased (P < .05) by 30% in the LIS group when compared with the C group. Taken cumulatively, these data suggest that a diet rich in soy protein may provide protective benefits regarding tumor development in female cancer-prone mice. Furthermore, some bioactive compounds in the HIS diet appeared to confound the soy protein-induced beneficial effects.