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PubMed2002

Extremely preterm vaginal breech delivery en caul.

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.

Adult↗
PubMed2005

Effects of soy protein and soy phytochemicals on mammary tumor development in female transgenic mice overexpressing human pituitary growth hormone.

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.

Animals↗
PubMed2002

Risk factors for invasive epithelial ovarian cancer: results from a Swedish case-control study.

This case-control study evaluated reproductive and other factors in relation to epithelial ovarian cancer (EOC) risk. Between 1993 and 1995, the authors recruited 655 EOC cases and 3,899 population controls aged 50-74 years who were born in and residents of Sweden. Data were collected through mailed questionnaires. Odds ratios were estimated by unconditional logistic regression. Parity reduced EOC risk (odds ratio = 0.61, 95% confidence interval (CI): 0.46, 0.81) for uniparous compared with nulliparous women. The risk of EOC decreased with incomplete pregnancies, early menopausal age, late age at first birth, and unilateral oophorectomy; increased with family history of ovarian cancer; and was not associated with menarcheal age, lactation, irregular menses, and menopausal symptoms. Histology-specific odds ratios of EOC for ever compared with never users of oral contraceptives were: serous, 0.56 (95% CI: 0.42, 0.74); mucinous, 1.96 (95% CI: 1.04, 3.68); endometrioid, 0.71 (95% CI: 0.49, 1.03); clear cell, 0.66 (95% CI: 0.31, 1.43); and all EOCs, 0.73 (95% CI: 0.59, 0.90). Prolonged oral contraceptive use reduced EOC risk, with persistent protection up to 25 years after the last use. Ever use of hormone replacement therapy increased EOC risk (odds ratio = 1.41, 95% CI: 1.15, 1.72). Among etiologic hypotheses, the retrograde transportation hypothesis accommodates most epidemiologic findings concerning EOC risk.

Age Factors↗
PubMedDate not supplied

Intravenous gammaglobulin in the prophylaxis of late sepsis in very-low-birth-weight infants: preliminary results of a randomized, double-blind, placebo-controlled trial.

The efficacy of intravenous immunoglobulin (IVIG) as prophylaxis for late sepsis was evaluated in a placebo-controlled, randomized, double-blind trial involving 240 infants of very low birth weight (less than 1,300 g). Each infant received a total of five doses of either IVIG (1 g/d) or an albumin placebo. The first four doses were administered between days 1 and 5 of life, and the last dose was administered on day 15 or shortly thereafter. Preliminary analysis of data available for 126 patients showed that in the first 30 days, sepsis developed in nine of 61 patients given IVIG and in 16 of 65 given placebo (one-tailed P = .065). At 70 days, the number who developed sepsis was similar in the two groups: 20 for those who received IVIG vs. 23 for those who received placebo. When patients with coagulase-negative staphylococcal infections were deleted from the totals, the results were essentially the same, i.e., three of 61 who received IVIG vs. nine of 65 who received placebo (one-tailed P = .041), developed sepsis during the first 30 days and 12 of 61 vs. 13 of 65, respectively, had developed sepsis at 70 days. In the IVIG group, the median peak level of serum IgG at day 7 was 1,700 mg/dL and the IgG levels were significantly greater than those in the placebo group for days 7-42. These data suggest that infusions of IVIG at the doses and dosing intervals used in this study may be effective in decreasing the incidence of late-onset sepsis during the first month of life in infants of very low birth weight.

Bacterial Infections↗
PubMed1998

Parapartum mental illness: a long-term follow-Up study.

All mothers (n = 79) in the county of Stockholm who gave birth to a child during 1976-77 and were also hospitalised for the first time in a psychiatric clinic were followed up after a mean interval of 15 years. The sample was classified according to the Research Diagnostic Criteria. Comparisons were made with matched obstetric controls. Five patients had died. The recurrence rate was 51% and 7. 3% relapsed after a subsequent childbirth. No difference was found between psychotic and non-psychotic mothers regarding mean sick-leave days per year. The majority of the women with a depressive disorder at index admission suffered from a minor depressive disorder. The women in the group with an unspecified functional psychosis showed a less severe course of illness than the women in the schizophrenia group.

Adult↗
PubMed1997

Evaluation of an educational program to prevent adolescent pregnancy.

The authors evaluated the effectiveness of a school-based sex education program in decreasing rates of sexual intercourse, improving birth control use, and decreasing the incidence of pregnancies among teenagers 16 years of age and younger. Twenty-one schools received either the McMaster Teen Program or the conventional didactic sex education program. Preprogram, the mean age of the students was 12.6 years. There were no statistically significant differences between groups in time to first sexual activity for males, chi 2(1) = 2.93, p = 0.09; time to first sexual activity for females, chi 2(1) = 0.50, p = 0.48; and time to first pregnancy, chi 2(1) = 1.90, p = 0.17. Significantly more experimental group males reported always using birth control at year 1 (difference 8.9%; 95% confidence interval [CI] = 0.4, 17.4). Limitations of the program that may have influenced the results were the exclusion of contraception information and its short duration.

Adolescent↗
PubMed2006

Parity and breast cancer risk among BRCA1 and BRCA2 mutation carriers.

INTRODUCTION: Increasing parity and age at first full-term pregnancy are established risk factors for breast cancer in the general population. However, their effects among BRCA1 and BRCA2 mutation carriers is still under debate. We used retrospective data on BRCA1 and BRCA2 mutation carriers from the UK to assess the effects of parity-related variables on breast cancer risk. METHODS: The data set included 457 mutation carriers who developed breast cancer (cases) and 332 healthy mutation carriers (controls), ascertained through families seen in genetic clinics. Hazard ratios were estimated by using a weighted cohort approach. RESULTS: Parous BRCA1 and BRCA2 mutation carriers were at a significantly lower risk of developing breast cancer (hazard ratio 0.54, 95% confidence interval 0.37 to 0.81; p = 0.002). The protective effect was observed only among carriers who were older than 40 years. Increasing age at first live birth was associated with an increased breast cancer risk among BRCA2 mutation carriers (p trend = 0.002) but not BRCA1 carriers. However, the analysis by age at first live birth was based on small numbers. CONCLUSION: The results suggest that the relative risks of breast cancer associated with parity among BRCA1 and BRCA2 mutation carriers may be similar to those in the general population and that reproductive history may be used to improve risk prediction in carriers.

Adult↗
PubMed2001

Differences in institutional cesarean delivery rates-the role of pain management.

BACKGROUND: The objective of our study was to compare cesarean delivery rates for low-risk nulliparous women in a community hospital and a tertiary-level maternity hospital and to determine factors influencing those rates. METHODS: We performed a retrospective cohort study of 857 women who did not have obstetric risk factors. The association between hospital and cesarean delivery rate was examined in a multivariate analysis using logistic regression. In a follow-up cohort study, we observed labor management for 24 couples in the community and 26 in the tertiary hospital. RESULTS: The odds of having a cesarean birth (age-adjusted) at the tertiary center were 3.4 (95% confidence interval, 2.1-5.4) compared with the community hospital. Maternal age, cervical dilatation on first examination, and use of epidural analgesia were the primary factors associated with the difference in cesarean delivery rates, with epidural analgesia having the largest effect. Labor support between the 2 hospitals appeared to be similar with the exception of increased use of ambulation in the community hospital and fewer numbers of caregivers for each woman in labor. Women in the tertiary center were more often offered epidural analgesia. CONCLUSIONS: Differences in use of epidural analgesia may contribute to differences in institutional rates of cesarean delivery. Use of epidural analgesia may be related to use of ambulation, consistency of caregiver during labor, availability of epidural, and suggestion for its use by caregivers.

Anesthesia, Epidural↗
PubMed1989

Reproductive and menstrual factors and risk of colorectal cancer.

The relation between reproductive and menstrual factors and the risk of colorectal cancer was investigated in a case-control study conducted in Northern Italy on 279 women with colon cancer, 153 with rectal cancer and 386 controls admitted to hospital for a wide spectrum of acute, nonneoplastic, nondigestive disorders. Compared with nulliparous women, the relative risks (RR) of colon cancer were 1.1 for one and two births, 1.3 for three or four, and 1.1 for five or more. Corresponding values for rectal cancer were 0.9 for one, 1.1 for two, 1.4 for three or four, and 0.8 for five or more births. No significant association emerged with number of abortions, and no consistent pattern of trends for both colon and rectum cancer was observed in relation to age at first or last birth. Women whose menarche occurred at age 15 or over were at significantly lower risk of colon cancer (RR 0.5, 95% confidence interval = 0.3-0.9), and the point estimate was below unity, though nonsignificantly, for rectal cancer too (RR = 0.7). There was no relation between age at menopause, duration of menstrual cycles, and cancers of the colon and rectum. The present study produced no evidence that reproductive factors are related to colorectal cancer in this population. With this sample size, it was possible to exclude relative risks below 0.8 for colon and 0.7 for rectal cancer among multiparous women versus nulliparous ones. These findings are thus inconsistent with the epidemiological evidence on reproductive and menstrual factors and breast cancer in this and other populations, with the sole potential exception of the reduced risk of colorectal cancer among women whose menarche occurred at age 15 or over.

Adult↗
PubMed1984

Immunological tolerance to spermatogenic cell antigens induced by teratocarcinoma stem cell antigens.

Repeated intraperitoneal administration of F9 teratocarcinoma stem cells (first dose of 3.8 X 10(8) + 3 doses of 7.5 X 10(8) cells at two-week intervals) to guinea pigs starting from birth prevented in more than one third of them (in 10 out of 28) the induction of autoimmune aspermatogenesis by subsequent immunization with spermatogenic cells emulsified with FCA. Cytotoxic and immunofluorescent activities against spermatogenic cells were similar in groups of males after tolerance induction and subsequent immunization and of males immunized only. However, these two groups differed substantially in serological activities against F9 cells which were significantly higher in the former group. The results are discussed in connection with the establishment of the blood-testis barrier which may have resulted in the absence of autotolerance towards spermatogenic cell antigens.

Animals↗
PubMedDate not supplied

Pregnancy termination in relation to risk of breast cancer.

OBJECTIVE: To evaluate the association between pregnancy terminations and risk of breast cancer. DESIGN AND SETTING: Population-based case-control study in Wisconsin, Massachusetts, Maine, and New Hampshire. STUDY PARTICIPANTS: Cases were women younger than 75 years with a new diagnosis of breast cancer (n = 6888), identified from statewide tumor registries. Controls younger than 65 years (n = 9529) were randomly selected from lists of licensed drivers, or for older subjects, from lists of Medicare beneficiaries. EXPOSURES AND OUTCOMES: Breast cancer risk in relation to spontaneous or induced abortions. RESULTS: After adjustment for parity, age at first birth, and other risk factors, pregnancy termination (induced or spontaneous) was associated with a relative risk (RR) of breast cancer of 1.12 (95% confidence interval [CI], 1.04 to 1.21), compared with the risk among women who had never had a termination. Induced terminations were associated with a RR of 1.23 (95% CI, 1.00 to 1.51), which was somewhat greater than the risk associated with spontaneous terminations (RR, 1.11; 95% CI, 1.02 to 1.20). The association with induced abortions was stronger for those performed before legalization of abortion in 1973 (RR, 1.35; 95% CI, 1.01 to 1.80) than after this time (RR, 1.12; 95% CI, 0.84 to 1.49), suggesting a bias in reporting this sensitive procedure. CONCLUSIONS: A weak positive association was observed between abortion--whether induced or spontaneous--and risk of breast cancer. The increase in risk of breast cancer was somewhat greater among women with a history of induced terminations. However, this association may be due to reporting bias and was not significantly different than the slight risk for spontaneous terminations.

Abortion, Induced↗
PubMed1998

Delayed-interval delivery in a quadruplet pregnancy after intrauterine death of a partial molar pregnancy and preterm delivery. A case report.

BACKGROUND: Delayed-interval delivery is infrequent in twin gestation and more rare in triplet and quadruplet gestation. Coexistence of a triploid pregnancy with a normal fetus has not previously been reported to have resulted in survival of the normal fetus. CASE: A 26-year-old woman, gravida 2, para 0-0-1-0, was diagnosed with a quadruplet pregnancy. At 16 1/2 weeks' gestation she developed preeclampsia and severe hyperemesis. Ultrasound was consistent with partial molar pregnancy in quadruplet D. Quadruplet D died in utero, and the preeclampsia and hyperemesis resolved. At 19 5/7 weeks, spontaneous rupture of the membranes and preterm labor occurred, and quadruplet A, stillborn female weighing 260 g, was delivered. With the use of antibiotic therapy, tocolysis and bed rest, the remaining two fetuses were maintained in utero until 32 6/7 weeks' gestation, when quadruplet B, a 1,470-g female, and quadruplet C, a 1,700-g female, were delivered. CONCLUSION: This was the first reported case of surviving fetuses coexisting with a partial molar pregnancy. This case was also complicated by preterm delivery and successful delayed-interval birth in a quadruplet pregnancy.

Adult↗
PubMed2002

Congenital heart block in neonatal lupus: the pediatric cardiologist's perspective.

CLINICAL PRESENTATION: Congenital heart block (CHB) in the absence of major structural abnormalities is associated with maternal antibodies to Ro (SS-A) and La (SS-B). CHB is most commonly diagnosed between 18 and 24 wk of gestation, and may be first, second or third degree (complete). Mortality approaches approximately 20%, and most surviving children require pacemakers. Affected infants may develop cardiomyopathy. Abnormalities in the skin, liver and blood of neonates are also associated with anti-Ro/La antibodies, and are usually self-limiting; these manifestations and CHB are collectively referred to as neonatal lupus syndromes (NLS). INVESTIGATION OF PATHOGENESIS: Recent studies demonstrate that Ro/La ribonucleoproteins appear on the surface of apoptotic fetal cardiocytes and are recognized by their cognate antibodies, promoting an inflammatory response. Mice immunized with Ro/La proteins have offspring with conduction abnormalities. In vitro, human serum and IgG with anti-Ro/La antibodies affect the conducting properties of isolated animal heart tissue. DIAGNOSTIC PROBLEMS: If fetal bradycardia is identified, a 2-dimensional and M-mode fetal echocardiographic and Doppler ultrasound should be obtained to determine whether there is an atrial arrhythmia or atrioventricular (AV) block, and to what degree, and whether there are major structural abnormalities of the heart. The mother's serum should be tested by ELISA for anti-Ro and/or anti-La antibodies. THERAPEUTIC OPTIONS: To date, only anecdotal and retrospective evidence guides in utero therapy of CHB. A prospective trial is currently underway to evaluate the efficacy of maternal oral dexamethasone in treating newly identified first, second or third degree block. Established third-degree block appears to be irreversible. Dexamethasone and sympathomimetics may be of some benefit in treating hydrops fetalis. In pregnant women with anti-Ro/La antibodies, prophylactic therapy is not indicated but serial echocardiographic analysis is strongly recommended, with emphasis on the mechanical PR interval to identify a reversible block. CONCLUSION: CHB occurs in approximately 1-5% of pregnancies in mothers with anti-Ro/La antibodies, independent of the mother's disease status, and in approximately 15-20% of pregnancies following the birth of a child with NLS. Treatment of CHB identified in utero is not established but guidelines are provided. Serial echocardiographic monitoring of high-risk pregnancies, using the mechanical PR interval to identify first degree block, may afford the earliest opportunities for therapeutic intervention.

Antibodies, Antinuclear↗
PubMed1993

Association of the common cold in the first trimester of pregnancy with birth defects.

OBJECTIVE: To examine the association between the common cold with or without fever in the first 3 months of pregnancy and birth defects in offspring. DESIGN: A case-control study. SETTING: Data are from the Shanghai Birth Defects Monitoring Program, conducted in 29 hospitals in Shanghai, China from October 1, 1986 to September 30, 1987. SUBJECTS: A total of 986 birth defects cases, 990 frequency-matched live birth controls, and 159 stillbirth controls. RESULTS: Modestly elevated risk of birth defects was identified among women who reported having a cold with or without fever in the first trimester of pregnancy. Notably increased relative risks were observed for anencephalus (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 2.0 to 7.7), spina bifida (OR = 4.1, 95% CI = 1.7 to 9.7), hydrocephalus (OR = 2.3, 95% CI = 1.1 to 5.1), cleft lip (OR = 2.2, 95% CI = 1.4 to 3.4), and undescended testicle (OR = 1.8, 95% CI = 1.0 to 3.0). Our study further found that the overall relative risks were consistent by using two different control groups, suggesting that this association was unlikely to be due to recall or report bias. CONCLUSION: Common cold in the first trimester of pregnancy may be associated with an increased risk of birth defects in offspring. However, these findings should be interpreted cautiously.

Adult↗
PubMed1985

The ontogeny of hypothalamic pituitary function in the pig. I. Pituitary LH and FSH in the fetus and neonate.

Pituitaries were collected from fetal and postnatal pigs from day 55 p.c. until 6 weeks after birth at closely spaced intervals. LH and FSH in individual pituitaries were quantified by both homologous RIA and homologous RRA. No significant difference was found between results obtained by RIA and RRA. Both LH and FSH are first detected by RIA and RRA in the porcine fetal pituitary at 75 days p.c. Thereafter both LH and FSH pituitary content rises until term. LH pituitary concentration in both male and female fetuses and FSH pituitary concentration in males exhibit a peak just before birth. FSH pituitary concentration in females rises until birth and thereafter remains elevated. A statistically significant sex difference was found postnatally with regard to FSH content and concentration but not for LH.

Animals↗
PubMed1982

Growth in the first year of life: effects of sex and weight for gestational age at birth.

Fifty-five small-for-dates (SFD), 56 average-for-dates (AFD) and 55 large-for-dates (LFD) babies were weighed and measured at regular intervals from birth to 12 months. Within the SFD and AFD groups weight gain was greater for boys than for girls so that by one year there were highly significant differences between the two sexes. Within the LFD group the sex difference was slight at all ages. Gain in length was similar to that for weight within each group; but head circumference showed a different pattern. Absolute increase in head circumference respectively for boys and girls between birth and one year was greatest in the SFD group and least in the LFD group. Within all three groups it was greater for boys than girls. By the age of six months AFD boys had larger heads than LFD girls and SFD boys had larger heads than AFD girls. At 12 months the head-circumference values for LFD girls and SFD boys did not significantly differ.

Birth Weight↗
PubMed1992

[Antenatal surveillance and risks of prematurity and fetal growth retardation].

The essential aim of this work was to investigate the relationship between antenatal care and preterm delivery or low birth weight. This study has been done by means of a case-control survey carried out among 435 women who delivered in 4 Maternity Hospitals in Aix-en-Provence-Pertuis area, between November 20th, 1987 and September 30th, 1988. Cases consisted of 124 women having delivered single livebirths before 37 weeks' gestation and 69 women having delivered, at term, single livebirths weighting less than 2,500 g. Controls were 242 women who delivered normal single livebirths. Results showed that, within the geographic area of the study, low birth weight and preterm delivery rates were respectively 6% and 5.4%. Antenatal care was generally according to medical profession recommendations: average number of visits: 7.9; first visit achieved, for 98.8% of women, within first trimester; intervention of a specialist in 97.1% of pregnancies; average number of ultrasound examinations: 3.5. Only mothers of low birthweight infants had more often an inadequate antenatal care (OR = 2.63, 95% confidence interval: 1.22-5.70). The risk factors for low birth weight were: previous history of preterm and/or low birth weight delivery, single marital status, low lever father's education, smoking during pregnancy, no contact with maternity team and for preterm delivery: previous history of preterm and/or low birth weight delivery, complications during the penultimate pregnancy, hypertension, metrorragies. These results suggest that it seems unlikely, in the future, to decrease unfavorable pregnancy outcomes by increasing antenatal care.

Case-Control Studies↗