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Postpartum maternal blood helper T (CD3+CD4+) and cytotoxic T (CD3+CD8+) cells: correlations with iron status, parity, supplement use, and lactation status.

Iron deficiency reduces T cell counts; however, iron sufficiency is difficult to maintain during pregnancy and to reestablish in the early postpartum period. This cross-sectional study examined relations among postpartum maternal iron status, parity, lactation, supplement use, and maternal blood T cell populations. Sixty lactating and 41 nonlactating postpartum (NLPP) women at 1-2 wk and 1, 2, 4, or 8 mo postpartum and 13 nulliparous women were studied. Among multiparous women, multiple linear regression showed that relative percentages and absolute numbers of CD3+CD8+ cells were correlated positively with maternal serum transferrin saturation. In a separate multiple linear regression model, multiparous NLPP women who did not use multivitamin and mineral supplements had lower CD3+CD4+ cell percentages in the first month postpartum than did nulliparous control women. Lactating women who used supplements, however, had reduced CD3+CD4+ percentages 4-8 mo postpartum compared with control women. CD3+CD4+ percentages did not differ among control women, NLPP women who used supplements, or lactating women who did not use them. These results suggest that nutritional factors such as maternal iron status and use of dietary supplements play a role in a mother's postpartum immune status.

Adult↗

Comparison of low-dose epidural with combined spinal-epidural analgesia for labour.

We have performed a randomized comparison of two low-dose epidural regimens for analgesia in labour, differing only in the manner in which initial analgesia was established. In the epidural (EPI) group, 484 women received a loading dose of 20 ml of 0.1% bupivacaine with fentanyl 2 micrograms ml-1. In the combined spinal-epidural (CSE) group, 524 women received a spinal injection of plain bupivacaine 2.5 mg with fentanyl 25 micrograms. In both groups, these initial doses were followed by 0.1% bupivacaine with fentanyl 2 micrograms ml-1 infused at a rate of 12 ml h-1, with 20-ml top-ups for breakthrough pain. The groups were compared for midwife assessment of analgesic efficacy, delivery mode, patient assessments of first stage analgesia, second stage analgesia, overall analgesia, motor block and complications. Midwives, who were not blinded to the treatment groups, assessed 61.6% of CSE as providing 'excellent' analgesia compared with 56.4% of epidurals (P = 0.02). Patients assessed overall analgesia as 'excellent' in 74.8% of CSE compared with 71.7% of epidurals (P = 0.14). Other comparisons between groups revealed no differences. These findings may have been affected by an uneven distribution of multiparous women between the groups (25% in the EPI group and 34.2% in the CSE group; P = 0.002). However, subgroup analysis of primiparous and multiparous women did not alter the results.

Adolescent↗

Mothers and daughters: intergenerational patterns of reproduction.

BACKGROUND: The objective of this study was to assess intergenerational mother-daughter patterns of reproduction. METHODS: In 1966, 12 055 pregnant women in Northern Finland, representing 96% of all births in the region, responded to a questionnaire in mid-gestation. In 1997-98, the 31-year-old daughters born from those pregnancies were sent a questionnaire and 4523 (80%) responded. Reproduction was compared between all mother-daughter pairs (n=4523) and separately for the pairs (n=489) of similar age (mothers 30-32 years). RESULTS: The menarcheal ages of the mothers and their daughters correlated slightly (Spearman correlation coefficient 0.206). The probability of the daughter to be multiparous was higher if her mother was multiparous at the time of the daughter's birth than if she was not. No association in the rate of spontaneous abortions was found. The first pregnancy of the daughters born from unwanted pregnancies was more often unwanted than the first pregnancy of the wanted daughters, after adjusting for parity (P=0.004). The analysis of the age-matched mother-daughter pairs gave similar results. CONCLUSION: A positive association between mothers and daughters in menarcheal age, parity and desirability of pregnancy was found.

Adolescent↗

Factors affecting home delivery in the Kathmandu Valley, Nepal.

This nested case-control study compares the characteristics of mothers having home or institutional deliveries in Kathmandu, Nepal, and explores the reasons given by mothers for a home delivery. The delivery patterns of mothers were identified in a cross-sectional survey of two communities: an urban area of central Kathmandu (Kalimati) and a peri-urban area (Kirtipur and Panga) five kilometres from the city centre. 357 pregnant women were identified from a survey of 6130 households: 183 from 3663 households in Kirtipur and Panga, 174 from 2467 households in Kalimati. Methods involved a structured baseline household questionnaire and detailed follow-up of identified pregnant women with structured and semi-structured interviews in hospital and the community. The main outcome measures were social and economic household details of pregnant women; pregnancy and obstetric details; place of delivery; delivery attendant; and reasons given for home delivery. The delivery place of 334/357 (94%) of the pregnant women identified at the survey was determined. 272 (81%) had an institutional delivery and 62 (19%) delivered at home. In univariate analysis comparing home and institutional deliverers, maternal education, parity, and poverty indicators (income, size of house, ownership of house) were associated with place of delivery. After multivariate analysis, low maternal educational level (no education, OR 5.04 [95% CI 1.61-15.8], class 1-10, OR 3.36 [1.04-10.8] compared to those with higher education) and multiparity (OR 3.1 [1.63-5.74] compared to primiparity) were significant risk factors for a home delivery. Of home deliverers, only 24% used a traditional birth attendant, and over half were unplanned due to precipitate labour or lack of transport. We conclude that poor education and multiparity rather than poverty per se increase the risk of a home delivery in Kathmandu. Training TBAs in this setting would probably not be cost-effective. Community-based midwife-run delivery units could reduce the incidence of unplanned home deliveries.

Adult↗

Effect of local lignocaine gel application for pain relief during suction termination of first-trimester pregnancy: a randomized controlled trial.

BACKGROUND: This study evaluated the effectiveness of local lignocaine gel application in pain control during first-trimester suction termination of pregnancy (STOP). METHODS: In this prospective randomized placebo-controlled double-blind trial, 131 women undergoing STOP between 7 and 10 weeks of gestation were studied. They were computer-randomized to receive 2% lignocaine gel or placebo (KY Jelly) locally applied to the cervix 1 min before cervical manipulation/dilatation. They all had cervical priming with misoprostol and premedication with diazepam and pethidine. Pain scores on a verbal analogue scale preoperative, at cervical manipulation/dilatation, intraoperative and 1 h post-operative, as well as the patients' satisfaction level towards pain control, were compared. RESULTS: The lignocaine gel group had significantly reduced overall intraoperative pain score compared with placebo group (P = 0.021). No significant difference in pain score between the two groups was demonstrated at other time points. Subgroup analysis revealed that the difference in overall intraoperative pain scores between the two groups was evident in the multiparous (P = 0.015) but not the nulliparous subjects. CONCLUSION: The use of local lignocaine gel application reduces overall intraoperative pain in multiparous women undergoing first-trimester STOP preceded by misoprostol cervical priming and premedication for conscious sedation.

Abortion, Induced↗

Gynaecological correlates of hysterectomy in Danish women.

BACKGROUND: The aim has been to assess the gynaecological characteristics of importance for hysterectomy performed for benign diseases. METHODS: In a prevalence study, 2301 Danish women aged 30, 40, 50, or 60 years, were selected at random in 1982, and self-report questionnaires were collected from 77%. Information about gynaecological and obstetric history, social background, weight and dieting history, and various lifestyles were recorded. Weight and height were measured. In an incidence study, the cohort was followed during 1982-1990 via central registers to assess the incidence of hysterectomy. Logistic and Cox regression were used to analyse data. RESULTS: In the prevalence study, 85% of the hysterectomies were performed for benign conditions. Early menarche (< or = 11 years old) and short-term use of oral contraceptives (OC) (1-4 years) were independent correlates of these hysterectomies by multivariate analyses, whereas multiparity (> or = 4 childbirths) was confounded by education and weight-related factors. Long-term use of OC was associated with lower prevalence of hysterectomy. In the incidence study, short-term use of OC and ever use of progestogen-only minipills were independent risk factors for hysterectomy performed recently for benign diseases in women under 50 in the multivariate analyses. Abortions did not reach significance, and neither multiparity, long-term use of OC, nor early menarche were important. CONCLUSION: The most important gynaecological characteristics related to premenopausal hysterectomy performed for benign diseases are hormonal contraceptives. These findings imply that the decision-making process concerning hysterectomy might depend on women's choice of contraception and compliance with OC as medical treatment.

Adult↗

Maternal cigarette smoking and the risk of pregnancy-induced hypertension and eclampsia.

BACKGROUND: Although previous studies have found that maternal smoking decreases the risk of pregnancy-induced hypertension (PIH), the difference of this effect between primiparous and multiparous women has not been well studied and the results of the exposure-response relationships between maternal smoking and PIH are inconsistent. No previous study has specifically examined the relationship between maternal smoking and eclampsia. METHODS: We analysed data from a population-based retrospective cohort study of 3 153 944 singleton pregnancies in the US. The data were derived from the national linked birth/infant mortality database for 1998. Multiple logistic regressions were used to describe the relationship between cigarette smoking and PIH and eclampsia. RESULTS: The adjusted odds ratios (ORs) [95% confidence intervals (95% CIs)] for PIH were 0.80 (0.77-0.83) for primiparous women and 0.81 (0.78-0.83) for multiparous women among smokers compared with non-smokers. The corresponding adjusted ORs (95% CIs) for eclampsia were 0.74 (0.66-0.82) and 0.75 (0.68-0.83), respectively. For PIH, the adjusted OR (95% CI) for smokers vs non-smokers were 0.82 (0.79-0.86), 0.81 (0.78-0.83), 0.80 (0.77-0.83), and 0.88 (0.79-0.98), respectively, for 1-5, 6-10, 11-20, and >20 cigarettes per day (test for trend: P = 0.86). The corresponding figures for eclampsia were 0.85 (0.75-0.95), 0.74 (0.66-0.82), 0.68 (0.58-0.78), and 0.73 (0.49-1.04), respectively (test for trend: P = 0.02). CONCLUSION: Maternal cigarette smoking decreases the risk of PIH and eclampsia, with a significant inverse exposure-response relationship apparent for eclampsia.

Adolescent↗

Parity as a risk factor for cervical cancer.

In a case-control study of 759 invasive cervical cancer patients and 1,430 controls in Colombia, Costa Rica, Mexico, and Panama conducted during 1986-1987, an association with number of pregnancies persisted after adjustment for sexual and socioeconomic variables. Risks rose steadily to 5.1 (95% confidence interval 2.7-9.7) for those with 14 or more pregnancies and a relation of risk to multiparity was observed in all four study countries. Pregnancy associations appeared to relate to the number of live births rather than to miscarriages or abortions, with multiparity relations most pronounced among premenopausal women and oral contraceptive users. Human papillomaviruses types 16 and 18, as measured by filter in situ hybridization, were not significantly associated with number of births and did not explain the strong relation of parity to risk. Our results indicate the need for further consideration of reproductive factors on cervical cancer risk, with attention given to possible mechanisms of action, including hormonal factors and cervical trauma.

Adult↗

Age, social rank and lactational status influence ovulatory patterns in seasonally breeding rhesus monkeys.

Rhesus monkeys housed outdoors exhibit a distinct breeding season limited to the fall and winter months. Four groups of female rhesus monkeys, multiparous nonlactating (MNL; n = 8), multiparous lactating (ML; n = 6), primiparous lactating (PL; n = 3) and nulliparous first-time ovulators (N; n = 6) were studied to investigate the influence of age, parity, and social dominance rank on the parameters of the breeding season. MNL exhibited the longest season (146 days), and PL the shortest (70 days), with N (106 days) and ML (89 days) intermediate. PL females also had a significantly reduced percentage of normal ovulations compared to other groups. Neither body weight nor estimates of body fat were related to either the timing of the ovulatory season or the quality of ovulations within the season. Parity and social dominance rank were significantly related to the percentage of normal ovulations (r = 0.85), with low-ranking, primiparous females exhibiting the fewest normal ovulations. These data indicate that the presence of a suckling infant acts synergistically with environmental factors to determine the parameters of the breeding season. Furthermore, postpubertal females may be more responsive to those factors that terminate the breeding season, and some factor independent of body weight but associated with low social dominance rank and/or primiparity renders females less capable of normal luteal function during the breeding season.

Age Factors↗

Antibody response of ewes and does to chimeric sheep-goat pregnancy.

Antibody production was evaluated in 62 recipients of blastomere-aggregation sheep-goat embryos, including 23 multiparous ewes, 21 multiparous does, 16 primiparous does, and 2 virgin does. The reactivity of sera collected weekly after the embryo transfer surgery was compared to that of sera collected prior to the embryo transfer by means of 1) complement-dependent cytotoxicity tests against peripheral blood lymphocytes (PBLs) from the parents of the embryo(s) and from random-bred sheep and goats, 2) hemagglutination and hemolytic assays with red blood cells (RBCs) from the two sires of the embryo(s), and 3) assays with PBLs and RBCs following absorptions with RBCs and PBLs from the parents and offspring. Although cross-reactivity to ovine and caprine PBL antigens was present in the control sera of some recipients, xenogeneic immunization during pregnancy was detected in 20 of 30 recipients that experienced term pregnancy. The xenogeneic response involved the production of antibody that reacted with both PBLs and RBCs. Allogeneic responses to RBCs were not observed, but allogeneic responses to PBLs occurred frequently, beginning after the onset of the xenogeneic response in most recipients (98 +/- 28 vs. 57 +/- 15 days in ewes; 93 +/- 23 vs. 46 +/- 7 days in does; mean day of onset +/- SD). The onsets of the responses were examined in conjunction with data collected on fetal and placental chimerism to evaluate possible routes of immunization. The onsets of the allogeneic responses and the limited serum reactivity to third-party PBLs suggested that fetal lymphocytes leaking across the placenta immunized the recipients to parentally inherited polymorphic antigens. The xenogeneic responses were associated with placental chimerism and appeared to involve the recognition of a species-specific monomorphic antigen shared by PBLs and RBCs. Neither of the responses appeared to affect continuation of pregnancy to term.

Animals↗

Failure of the estrous cycle and spermatogenesis to respond to day length in a subtropical African rodent, the pouched mouse (Saccostomus campestris).

Little is known about the role of photoperiod in the control of reproduction in mammals from the tropics in general and, in particular, from the Afrotropics. The present study examined the reproductive photosensitivity of the pouched mouse (Saccostomus campestris: Cricetidae), a small, seasonally breeding rodent that occurs from about 12 degrees S to 33 degrees S in Africa. Groups of 10 laboratory-bred male pouched mice were exposed to either long-day (16L:8D) or short-day (8L:16D) conditions for 14 wk, after which they were killed and the spermatogenic activity of the testes was assessed histologically. A group of 10 adult, multiparous females were exposed to long-day conditions for 3 mo, after which the lengths of five consecutive estrous cycles were measured. Thereafter, day length was reduced to 10L:14D, and after 16 days acclimation, the lengths of five estrous cycles were measured. Finally, day length was reduced to 8L:16D, and after 33 days, the lengths of five estrous cycles were measured. Day length had no influence on body size, testis size, or the histology of the testis, and all specimens were actively producing spermatozoa. The length of the estrous cycle (4.0 +/- 0.3 days under long-day conditions) did not change significantly with the decrease in photoperiod. In a third experiment, 14 multiparous and six nulliparous females that had been maintained under short-day conditions for 33 days were mated and successfully reared litters.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗

Analgesia, pruritus, and ventilation exhibit a dose-response relationship in parturients receiving intrathecal fentanyl during labor.

UNLABELLED: Several studies have characterized the 50% and 95% effective doses (ED50 and ED95, respectively) of intrathecal sufentanil for labor analgesia. Few have investigated these same criteria for the less expensive alternative, fentanyl. In addition, the ventilatory effects of intrathecal fentanyl at clinically relevant doses are unclear. We performed this study to establish the dose-response relationship of intrathecal fentanyl for both analgesia and ventilatory depression. Ninety parturients in active early labor (< or = 5 cm dilation) received intrathecal fentanyl 5, 7.5, 10, 15, 20, or 25 micrograms in a double-blinded, randomized fashion (n = 15 patients in each group). Parturients were monitored for degree of pain (measured using a 100-mm visual analog pain scale), blood pressure, arterial oxygen saturation (SaO2), respiratory rate, ETCO2, and fetal heart rate 0, 1, 5, 10, 15, 20, 25, and 30 min after the administration of intrathecal fentanyl. An absolute visual analog pain scale score < or = 25 mm was defined a priori as analgesic success. The percentage of parturients who achieved analgesic success was used to construct quantal dose-response curves, from which the ED50 and ED95 values were derived for the total population (mixed parity) and the nulliparous and multiparous subpopulations separately. Overall ED50 and ED95 values (95% CI) were 5.5 (3.4-7.2) and 17.4 (13.8-27.1) micrograms, respectively. Nulliparous values were lower (5.3 and 15.9 micrograms, respectively) than multiparous values (6.9 and 26.0 micrograms, respectively) but were within the 95% CIs of the total population. Pruritus incidence in parturients with analgesic success displayed a dose-response relationship identical to that seen for analgesia. ETCO2 displayed a dose-related increase, particularly at doses > or = 15 micrograms, without concomitant changes in respiratory rate or SaO2, which suggests a decrease in tidal volume. Even in the absence of overt signs or symptoms of somnolence, intrathecal fentanyl at doses within the effective analgesic range induced a change in ventilation that may last longer than the 30-min period we studied. IMPLICATIONS: Intrathecal fentanyl induces rapid and satisfying dose-dependent analgesia in early labor; however, it also produces dose-related decreases in ventilation in the absence of overt somnolence.

Adult↗

Placenta accreta: mild cases diagnosed by placental examination.

We describe 36 placentas in which microscopic foci of myometrial tissue were adherent to the basal plate with deficient intervening decidua, consistent with a mild or focal form of placenta accreta. In only four cases was a diagnosis of placenta accreta considered clinically, and none of the cases resulted in hysterectomy. Twenty-one of the mothers underwent cesarean section for the current pregnancy, with 10 of the mothers having a history of previous cesarean section. The placenta failed to separate spontaneously in eight of the 15 vaginal deliveries necessitating manual removal of the placenta. Additional maternal factors included multiparity in 33, placenta previa in two, leiomyomas in two, and previous spontaneous abortion or voluntary interruption of pregnancy in 23. Four cases were complicated by retained placental fragments and three by postpartum hemorrhage. We conclude that these milder cases of placenta accreta are frequently associated with previous uterine operations and multiparity, and although not uncommon, are frequently not clinically suspected. Placental examination is useful in making the diagnosis of placenta accreta in cases not requiring hysterectomy, particularly if the basal plate is well sampled.

Adolescent↗

Immune maladaptation in the etiology of preeclampsia: a review of corroborative epidemiologic studies.

Genuine preeclampsia is a disease of first pregnancies. The protective effect of multiparity, however, is lost with change of partner. Also, exposure to semen provides protection against developing preeclampsia. Analogous to altered paternity, artificial donor insemination and oocyte donation are reported to result in a substantial increase of preeclampsia. Thus, epidemiologic studies strongly suggest that immune maladaptation is involved in the etiology of preeclampsia. Although the exact etiology of preeclampsia remains unknown, the conclusions derived from epidemiologic studies may have consequences for practicing physicians: 1) according to the primipaternity concept, a multiparous women with a new partner should be approached as being a primigravid women; 2) artificial donor insemination and oocyte donation are associated with an increased risk of developing pregnancy-induced hypertensive disorders; 3) a more or less prolonged period of sperm exposure provides a partial protection against pregnancy-induced hypertensive disorders. In the 1990s, all women with changing partners are strongly advised to use condoms to prevent sexually transmitted diseases. However, a certain period of sperm exposure within a stable relation, when pregnancy is aimed for, is associated with a partial protection against preeclampsia.

Female↗

Assessment of the risk for broad sensitization by blood transfusions.

The risk factors associated with the production of lymphocyte antibodies were studied by evaluating the conditions of sensitization in 73 renal failure patients and by searching for lymphocyte antibodies by flow cytometry before the induction of overt sensitization by blood transfusions. In 14 patients the lymphocytotoxic antibodies were not broadly reactive and became undetectable within 5 months. These patients were mostly first transplant candidates who received transfusions prior to the rise of panel antibody reactivity. The remaining 59 patients developed broadly reactive antibodies that persisted for longer than 5 months, regardless of whether or not they were given subsequent blood transfusions. This group was made up almost exclusively of multiparous women or patients who had previously lost a kidney graft. There were 13 patients having no lymphocytotoxic antibodies who developed broad sensitization after blood transfusions. These patients were also multiparous women or previously transplanted patients, suggesting that previous exposure to alloantigens by transplants or pregnancies appeared to be a precondition for blood transfusions to induce broad sensitization. This was confirmed by detecting lymphocyte antibodies by flow cytometry in the pretransfusion serum of 9 of the 13 patients. In contrast, patients who did not make antibodies after transfusions, or those who developed temporary responses, did not have lymphocyte antibodies in their pretransfusion specimens. These findings suggest that patients with low levels of lymphocyte antibodies, not detectable by standard cytotoxicity, are at high risk of developing broadly reactive cytotoxic antibodies after blood transfusions.

Antilymphocyte Serum↗

Mucosal alloimmunization elicits T-cell proliferation, CC chemokines, CCR5 antibodies and inhibition of simian immunodeficiency virus infectivity.

The hypothesis was tested that mucosal stimulation with unmatched mononuclear cells would induce systemic alloimmune responses. Rectal or vaginal mucosal administration of 10(4)-10(7) unmatched mononuclear cells induced significant dose-dependent T-cell proliferation stimulated by the allogeneic cells in rhesus macaques. This was associated with a significant upregulation of CD8(+) T-cell-derived suppressor factor, as well as the CC chemokines CCL3, CCL4 and CCL5. In addition, there was a dose-dependent increase in antibodies to CCR5. These responses were associated with decreased in vitro simian immunodeficiency virus (SIV) infectivity of CD4(+) T cells. A further investigation of SIV infectivity of CD4(+) T cells separated from multiparous macaques also showed significant inhibition compared with male macaques. It is suggested that vaginal or rectal exposure to allogeneic stimulation by a partner's HLA antigens in seminal fluid, as occurs during sexual intercourse, or immunization by semi-allogeneic fetuses in multiparous females may elicit protection against SIV or human immunodeficiency virus infection.

Administration, Intravaginal↗

Use of antenatal services in Kampung District, Cambodia.

This study was conducted to assess factors that influence use of antenatal care services with both quantitative and qualitative designs. Methods used were structured questionnaire interviews and focus group discussions in the Kampung District, Kampot Province in Cambodia with a volunteer sample of 260 postnatal mothers. The outcome measure was factors influencing use of antenatal care services. The results showed that first-time mothers (primigravidas) were more likely to use antenatal services than multiparous mothers (OR = 1.87; p = 0.001). Mothers with some school education used antenatal services more than those with no school education (OR = 2.0; p = 0.01). Mothers engaged in professional occupations by virtue of their higher levels of educational attainment were more likely to use antenatal services than those engaged in agriculture (OR = 2.54; p = 0.001). Use of antenatal care services was higher in the districts whose health centers were supported by a foreign nongovernmental organization as compared to other districts with no such support (OR = 2.44; p = 0.001). Although services were generally inadequate, those that existed were underutilized by the mothers. Major factors influencing use of services include distance, lack of transport, and lack of awareness of the benefits of antenatal care by the mothers, thus resulting in a general notion that antenatal care is only important when problems occur during pregnancy. It is concluded that for remote villages, mobile antenatal clinics should be provided to improve access, and greater emphasis should be placed on health educating the mothers about the potential benefits of antenatal care, with special attention to multiparous mothers and those from the lower socio-economic class, among whom use of antenatal services was lowest.

Adolescent↗

Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study.

OBJECTIVE: To describe a general population of women with regard to factors associated with urinary and fecal incontinence and genital prolapse symptoms. METHODS: A questionnaire about medical background, urinary and fecal incontinence and genital prolapse symptoms was mailed to 100040-year-old and 100060-year-old Swedish women. Associations were described by odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Sixty-seven percent answered the questionnaire. Multivariate analysis showed urinary incontinence to be associated with anal sphincter rupture [OR 4.4 (95% CI 1.0-18.8)], pelvic heaviness [3.8 (2.1-7.0)], body mass index (BMI) >or=30 kg/m2[3.7 (2.0-6.7)], multiparity [1.8 (1.0-3.4)], varicose veins surgery [1.9 (1.2-3.2)] and age [1.9 (1.2-3.2)]. Univariate analyses revealed statistically significant associations between urinary incontinence and incontinence for flatus [4.8 (3.0-7.8)], for liquid stool [5.0 (2.9-8.6)] and for solid stool [5.9 (2.4-14.2)]. Chronic bronchitis [5.7 (1.7-18.9)] was strongly associated with urinary incontinence but was only reported by the older age group. Prolapse symptoms were strongly associated with both urinary and fecal incontinence. Prolapse symptoms as opposed to urinary and fecal incontinence seemed to be associated more with injuries at delivery than with chronic pelvic floor strain. CONCLUSIONS: Women with urinary incontinence are also likely to suffer from fecal incontinence and prolapse and vice versa. Other associated factors for pelvic floor dysfunction were overweight, and especially obesity, chronic bronchitis, vaginal delivery and multiparity, age, heredity and diseases suggestive of collagen disorders. A multidisciplinary management of women with pelvic floor symptoms is suggested and possible prevention is discussed.

Abdomen↗