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PubMed2005

High parity and adverse birth outcomes: exploring the maze.

BACKGROUND: Despite extensive literature on the topic, it is uncertain if grand (para > or = 5) and great grand (para > or = 10) multiparity are associated with adverse birth outcomes. We critically evaluate the evidence for and against the existence of adverse maternal and/or fetal outcomes in high parity women. METHODS: An electronic search of MEDLINE and other bibliographic databases (Current Contents, EMBASE, and CAB) was conducted, and all relevant articles in English language were retrieved. RESULTS: Findings on the association between high parity and maternal-fetal birth outcomes are not consistent. Although the older literature tends to suggest that multiparity is a risk factor for negative birth outcomes, more recent reports are not supportive. Comparison across studies was further complicated by confounding factors like maternal age, socioeconomic status, and levels of prenatal care, as well as by variations in study designs and in the definition of parity itself. Furthermore, most studies that examined women of extreme parity (para > or = 10) were handicapped by inadequate power. CONCLUSIONS: After accounting for quality, culture, and degrees of associations, the preponderance of evidence seems to point to possible existence of heightened risk for certain medical complications and placental pathologies among women of extreme parity. The literature also provides reasonable evidence for a higher-than-expected likelihood for occurrence of fetal macrosomia with advanced parity.

Female↗
PubMed1982

Evaluation of different technical approaches for the research of human anti-Ia alloantisera.

Several strategies have been proposed for the research of human anti-Ia alloantisera. The present work evaluates the results of a screening made on multiparous sera, using either platelet-absorbed sera or unabsorbed sera against cells coated by anti-human-beta-2-microglobulin antibodies. When the results of the two approaches were compared, it was observed that the latter shows a higher frequency of positive reactions, being able to detect weak anti-Ia, and possibly non-HLA antibodies, which are not revealed with the usual test on platelet-absorbed serum. A significant correlation has been noted between the presence of anti-HLA-A,B,C and of anti-Ia, demonstrating that the best source of Ia antibodies from multiparous women are sera also containing anti-HLA-A,B,C.

Blood Grouping and Crossmatching↗
PubMed1993

Nucleotide sequences of the variable regions of a human monoclonal antibody against HLA-A1, A23, and A24.

Nucleotide sequences of the heavy and light chain variable (VH and VL) regions of a human monoclonal antibody (4-35-7), which recognized HLA-A1, A23 and A24, were determined by means of the reverse transcriptase-polymerase chain reaction. This antibody was generated by Epstein-Barr virus transformation of lymphocytes obtained from a multiparous donor, followed by fusion with mouse myeloma cells. The VH gene segment belonged to the VHIII gene family, and used the DXP4 and JH4 gene segments. This VH gene segment had 92.9% homology to the germline gene VH26, and contained 21 nucleotide substitutions. Fourteen of them generated the replacements of amino acids, while 7 failed to generate the replacement. The ratio of replacement to silent mutations in complementarity determining regions (CDRs) was 7.0. The VL gene segment belonged to the VkI gene family, and used Jk4. This VL gene segment showed 96.1% homology to the germline gene HK102, and contained 11 nucleotide substitutions. Seven of them generated the replacement of amino acids, while 4 failed to generate the replacement. The high ratio of replacement to silent mutations in CDRs of the VH gene segment suggested that the multiparity caused the processes of antigenic selection and somatic mutation, and generated this anti-HLA antibody.

Amino Acid Sequence↗
PubMed2005

Postpartum neurologic symptoms following single-shot spinal block for labour analgesia.

BACKGROUND: As part of a quality assurance program, we investigated the incidence of postpartum neurologic symptoms in multiparous parturients receiving spinal block for labour analgesia, now in routine use in our labour ward. METHODS: Two hundred and twenty-nine consecutive multiparous parturients presenting for vaginal delivery and requesting spinal analgesia were asked to participate in this prospective study. All parturients received our standard intrathecal analgesia (ITA): 2.5 mg bupivacaine (1 ml) + 25 microg fentanyl (0.5 ml) using a 27-gauge Quincke-type needle. The patients filled in a questionnaire on the first day after delivery and again upon discharge. Complaints typical of neurologic sequelae were noted and a neurologic examination was performed, if necessary. All patients with postdural puncture headache (PDPH) and transient neurologic symptoms (TNSs) were interviewed by telephone 2 weeks after discharge to determine the course of the symptoms. RESULTS: Two hundred and twelve parturients were included in the study. Eighteen (8.5%) parturients complained of PDPH, the severity of which was mild in eight (4%), moderate in seven (3%), and severe in three (1%) patients, respectively. Fifteen (7%) mothers were treated with analgesics or bedrest only. Three (1%) patients were given an epidural blood patch. The paramedian approach was associated with the development of PDPH (P = 0.04). Transient neurologic symptoms were experienced by nine (4.2%) mothers, lasting 1-3 days, mostly presenting as bilateral pain in the buttocks or thighs. One parturient suffered from paraesthesia of the left foot lasting for 3 days. Forty (19%) mothers complained of non-postural headache and 28 (13%) of new-onset back pain. Three mothers (1%) would not want to receive a further spinal block. CONCLUSION: Transient neurologic symptoms (TNSs) after spinal block occurred infrequently. The incidence of PDPH was higher than in the obstetric population in general and calls for re-evaluation of our spinal block methods. Despite the occurrence of neurologic sequelae, patient acceptability was high.

Adult↗
PubMed2004

The acyclic period postpartum in automatic and conventional milking.

The acyclic postpartum period in cows is prolonged due to frequent suckling when compared with twice daily milking. In conventional milking systems twice daily milking is common, while in automatic milking systems (AMS) three or more milkings are performed in early lactation. In this study, the hypothesis was tested that an increased milking frequency in AMS causes a delay in resumption of ovarian cyclicity postpartum and increases days open in German Fleckvieh cows (n = 124). Calvings were equally distributed throughout the 1-year experimental period. All cows were housed in one barn. Sixty-three cows were milked in an AMS (AC) and 61 cows were twice daily milked in a conventional milking parlour (PC). Forty-two AC and 36 PC remained in the herd until conception. After parturition, milk samples were analysed for progesterone twice weekly to record the ovarian activity until pregnancy was diagnosed. The first and the second ovulation were determined by the progesterone profile of each individual cow. The mean milking frequency during the first 3 weeks after parturition was higher in AC (3.17 +/- 0.09 milkings/day) than in PC (milked twice daily). The individual mean milking frequency of AC for the first 3 weeks of lactation ranged from 2.0 to 5.9 daily milkings. The time span from parturition until the first and second ovulation did not differ between AC and PC. However, first ovulation was observed earlier in primiparous (23 +/- 1 days) than in multiparous cows (29 +/- 1 days, P < 0.05). Within AC no relationship between milking frequency and duration of the acyclic period was observed. Days open did not significantly differ between AC and PC and between primiparous and multiparous cows. In conclusion, the increased milking frequency in AMS did neither cause a delay in resumption of ovarian cyclicity postpartum nor did it increase days open.

Anestrus↗
PubMed1991

An evaluation of the pelvic score by the quantification theory for categorical data.

The scoring system for pelvic examination used in Tsukuba University Hospital was evaluated by the quantification theory to investigate the precision in predicting the date of labor onset. The objects of this study were 137 nulliparous gravidae and 142 multiparous gravidae who had spontaneous onset of labor at full-term. In this analysis, we used 15 categories of findings in the examination as independent variables, and as the objective variable we used the interval from the examination to the labor onset. The multiple correlation coefficients in nulliparae was 0.593 and in multiparae 0.598. The following conclusions were reached concerning the assessment of labor onset: (1) The consistency of the cervix and the engagement of the vertex in nulliparous gravidae should be given more consideration. (2) In multiparous gravidae the dilatation of the cervix and the engagement of the vertex are important factors. (3) A different scoring system should be employed for both nulliparae and multiparae.

Evaluation Studies as Topic↗
PubMed1980

Factors affecting plasma angiotensin II concentration in labour.

Concentrations of plasma angiotensin II (AII) have been measured in the second stage of labour or before delivery by elective Caesarean section in 134 women and some factors influencing the levels have been assessed. Plasma AII concentrations in the second stage of labour were higher than levels previously observed before the onset of labour in both primigravid and multiparous women. Markedly lower levels were found following delivery by elective Caesarean section than following vaginal delivery. Multiparae had higher AII concentrations than primigravidae both before the onset of labour and at delivery. Epidural analgesia was associated with significantly lower AII concentrations; in primigravidae receiving such analgesia a statistically significant relation was found between AII concentration and diastolic blood pressure at delivery. A similar relation was found in the nonproteinuric patients delivered by Caesarean section. The estimated duration of the second stage of labour was the major factor affecting AII concentration in normal multiparae. In both primigravid and multiparous women, AII concentrations were markedly raised in association with proteinuria.

Adult↗
PubMed1993

Postpartum haemorrhage in Zimbabwe: a risk factor analysis.

OBJECTIVES: To identify risk factors associated with postpartum haemorrhage (PPH) in order to improve the effectiveness of antenatal screening. DESIGN: A population-based case control study. SETTING: Harare, Zimbabwe. SUBJECTS: Two groups of women, one group consisting of those with postpartum haemorrhage after a normal vaginal delivery and the other of women with normal unassisted vaginal delivery without PPH. METHOD: Data abstracted from the medical records; relative risks were estimated by multivariate logistic regression. RESULTS: Low parity, advanced maternal age, and antenatal hospitalisation were among the strongest risk factors, with more modest associations for history of poor maternal or perinatal outcomes and borderline anaemia at the time of booking. No association with grand multiparity was found. CONCLUSIONS: These findings confirm the importance of previously recognised factors such as low parity, poor obstetric history, anaemia, and prolonged labour, but call into question the significance of grand multiparity. Previously undocumented factors such as maternal age greater than 35 years and occiput posterior head position emerged as predictors worthy of further investigation.

Adolescent↗
PubMed1997

Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy.

OBJECTIVE: To determine risk factors for third degree obstetric perineal tears and to give recommendations for prevention. DESIGN: Retrospective case control study. SETTING: A teaching hospital in The Netherlands. PARTICIPANTS AND METHODS: One hundred and twenty cases of vaginal delivery complicated by third degree perineal tear and 702 uncomplicated vaginal deliveries were compared, with respect to possible risk factors. RESULTS: In a multivariate model high birthweight, forceps delivery, induced labour, epidural anaesthesia and parity were risk factors for anal sphincter tear. In addition, mediolateral episiotomy was associated with fewer sphincter injuries. Separate analysis of nulli- and multiparous women demonstrated that high birthweight and epidural anaesthesia (increased risk) and mediolateral episiotomy (decreased risk) were factors associated with anal sphincter tear only in nulliparous women. CONCLUSIONS: We found several risk factors for anal sphincter tear. Nulliparous women are at higher risk than multiparous women. Mediolateral episiotomy may be sphincter-saving especially in nulliparous women and therefore prevent them from chronic faecal incontinence.

Adult↗
PubMed1999

Intramuscular opioids for maternal pain relief in labour: a randomised controlled trial comparing pethidine with diamorphine.

OBJECTIVE: To compare the pain relief and side effects of intramuscular pethidine with intramuscular diamorphine in labour. DESIGN: Double-blind randomised controlled trial. SETTING: The labour ward in a UK teaching hospital. PARTICIPANTS: Sixty-nine nulliparous women and 64 multiparous women in labour who requested narcotic analgesia and remained undelivered one hour after trial entry. METHODS: Nulliparous women were randomised to receive either 150 mg intramuscular pethidine or 7.5 mg intramuscular diamorphine. Multiparous women were randomised to receive either 100 mg intramuscular pethidine or 5 mg intramuscular diamorphine. All participants received the anti-emetic prochloroperazine at the same time as the trial drugs. MAIN OUTCOME MEASURES: Maternal analgesia assessed by a visual analogue score and verbal scales of pain intensity and pain relief, maternal sedation and vomiting, neonatal outcome assessed by Apgar scores and the need for resuscitation. RESULTS: More women allocated to receiving pethidine than to diamorphine reported slight or no pain relief at 60 minutes after administration of these drugs (P = 0.03). This trend was repeated in most of the other measures for maternal analgesia. There was no difference in maternal sedation, but the incidence of vomiting within 60 minutes was lower for women who received diamorphine (P = 0.02). Pethidine was associated with lower Apgar scores at 1 minute (P < 0.05). CONCLUSION: Intramuscular diamorphine in labour appears to have some benefits, compared with intramuscular pethidine, but the trial was small and further research, particularly into alternative opioids and long term effects on the infants is still needed.

Analgesics, Opioid↗
PubMed2000

The views and anticipated needs of women in early pregnancy.

OBJECTIVE: To assess the expectations of antenatal care of pregnant women at the outset of pregnancy. DESIGN: Questionnaire study within a randomised controlled trial, comparing traditional antenatal care with a more flexible schedule. SETTING: Eleven primary care centres providing midwifery care in Avon. POPULATION: Five hundred and ninety-three pregnant women at low risk of obstetric complications presenting for antenatal care. METHODS: A questionnaire was completed by women who agreed to participate in the trial shortly after antenatal booking. The questionnaire explored women's views on their attitudes to pregnancy and antenatal care, the locus of control related to pregnancy, the planning of the pregnancy and expectations of care. MAIN OUTCOME MEASURES: Comparisons between nulliparous and multiparous women in terms of their views of antenatal care, and their stated preference for a particular package of care. RESULTS: There was no difference in their views of pregnancy as an event entailing risk. On a locus of control scale that measured women's perceptions of factors which might affect their babies' health, nulliparous women rated antenatal care higher than multiparous women (P = 0.0001). However, this was not associated with any difference between the two groups in their stated preference for traditional or flexible care. Approximately half of the women expressed no preference, and of those who did 61% would opt for traditional care. Almost one-fifth of the whole sample welcomed the idea of flexible care. DISCUSSION: These data support the evidence of previous studies that there remains a strong desire among pregnant women to receive a 'traditional' pattern of care, even among those who have previously experienced normal pregnancy. However, a minority can be identified at the outset of pregnancy who may welcome a change to a more flexible pattern of care.

Attitude to Health↗
PubMed2001

In vivo controlled release of PGE2 from a vaginal insert (0.8 mm, 10 mg) during induction of labour.

OBJECTIVE: To measure the release rate of prostaglandin E2 (PGE2) in vivo from a controlled-release vaginal insert used for cervical ripening and induction of labour at term in women with intact membranes or pre-labour rupture of membranes (PROM). DESIGN: Open-label, single centre study. POPULATION: Women at term (> or = 37 gestational weeks) with unripe cervices (Bishop score < or = 6) scheduled for labour induction for mainly medical reasons. METHODS: sixty-eight women (47 with intact membranes and 21 with PROM) had the PGE2 vaginal insert placed in the posterior fornix of the vagina. Each insert was removed from the women at a predetermined time interval between 0.5 h and 24 h, or earlier if labour was induced, fetal distress was detected or maternal complications occurred. After removal, the vaginal insert was frozen and stored for subsequent assay of residual PGE2. Blood samples were collected immediately before insertion and at 4-hour intervals until removal of the vaginal insert to determine plasma concentrations of PGE2 and the major PGE metabolite, 15-Keto-13, 14-dihydro-PGF2alpha (PGEm). Vaginal pH was measured immediately before insertion and directly after removal of the vaginal insert. Bishop score was assessed before induction, after 8 h, 12 h and immediately after removal of the vaginal insert. RESULTS: There was a positive linear relationship between the amount of PGE2 released from the insert and the duration of treatment in women with intact membranes (rp = 0.95, P = 0.0001), with a calculated PGE2 release rate of 0.52 +/- 0.33 mg/h over 24 h. The PGE2 release rate in women with PROM was not linear. The PGE2 release rate was dependent on vaginal pH, with a faster release rate at higher vaginal pH. Forty-seven women (69.1%) had the insert removed due to the successful induction of labour and consequently discontinued study treatment before their allocated time period. At vaginal delivery, the released amount of PGE2 at onset of labour was 4.0 +/- 3.0 mg and 2.4 +/- 2.1 mg for nulliparous women with PROM and intact membranes, respectively (P = 0.1). In multiparous women, the equivalent mean released amount was 3.2 +/- 2.6 mg and 1.9 +/- 1.4 mg, respectively (P = 0.14). In women with intact membranes, the mean plasma concentrations of PGE2 and PGEm after treatment were not statistically different to those women with PROM (P = 0.27 and 0.64, respectively). In women who were delivered vaginally, the median induction to delivery time interval was 17.0 h (range 4-42) in nulliparous women and 8.7 h (range 5-19) in multiparous women (P = 0.003). Ten (14.7%) women, who were all nulliparous, were delivered by caesarean section. CONCLUSIONS: In women with intact membranes, the PGE2 release rate was linear over 24 hours. There was a positive linear relationship between vaginal pH and PGE2 release rate. The metabolite analysis revealed no evidence of dose dumping neither in women with intact membranes or in women with PROM.

Adult↗
PubMed2002

Comparative levels of psychological distress, stress symptoms, depression and anxiety after childbirth--a prospective population-based study of mothers and fathers.

OBJECTIVE: To compare maternal and paternal psychological responses following birth of a healthy baby; and to explore predictors of parental psychological distress. DESIGN: A prospective, longitudinal, population-based cohort study. SETTING: A Norwegian district general hospital. POPULATION: One hundred and twenty-seven mothers and 122 fathers were included. METHODS: Eligible consenting parents were enrolled. The assessments, which were performed zero to four days after birth, at six weeks and at six months, included General Health Questionnaire-28 (GHQ-28), State Anxiety Inventory and Impact of Event Scale. The response rates at the three occasions were 97%, 85% and 71%. MAIN OUTCOME MEASURES: Symptoms of intrusion, avoidance, arousal and psychological distress including anxiety, depression, social dysfunction and somatisation. RESULTS: Clinically important psychological distress was reported by 37% of the mothers and 13% of the fathers a few days after childbirth (P < 0.001). Severe intrusive stress symptoms were reported by 9% and 2% of mothers and fathers, respectively (P = 0.002). Level of intrusive stress was the outcome that differed most clearly between mothers and fathers at all three points of time. Being a single parent, multiparity and a previous traumatic birth were significant independent predictors of acute maternal psychological distress. After six weeks and six months, the level of psychological distress including symptoms of depression fell to levels found in the general population. CONCLUSIONS: Childbirth does not seem to trigger long term psychological distress in most parents. Clinically important psychological distress occurred more frequently in mothers than in fathers. Acute maternal psychological distress was predicted by being a single parent, being multiparous, and having a previous traumatic birth.

Adolescent↗
PubMed2006

Does size matter? A population-based study of birth in lower volume maternity hospitals for low risk women.

OBJECTIVE: To study the association between volume of hospital births per annum and birth outcome for low risk women. DESIGN: Population-based study using the National Perinatal Data Collection (NPDC). SETTING: Australia. PARTICIPANTS: Of 750,491 women who gave birth during 1999-2001, there were 331,147 (47.14%) medically 'low risk' including 132,696 (40.07%) primiparae and 198,451 (59.93%) multiparae. METHODS: The frequency of each birth and infant outcome was described according to the size of the hospital where birth took place. We investigated whether unit size (defined by volume) was an independent risk factor for each outcome factor using public hospitals with greater than 2000 births per annum as a reference point. MAIN OUTCOME MEASURES: Rates of intervention at birth and neonatal mortality for low risk women in relation to hospitals with <100, 100-500, 501-1000, 1001-2000 and >2001 births per annum. RESULTS: Neonatal death was less likely in hospitals with less than 2000 births per annum regardless of parity. For multiparous low risk women in hospitals of 100 and 500 births per annum compared with hospitals of >2000 births per annum the adjusted odds of neonatal mortality [adjusted odds ratio (AOR) 0.36; 99% confidence interval (CI) 0.14-0.93]. For low risk primiparous women in hospitals with less than 100 births per annum, there were lower rates of induction of labour (AOR 0.62; 99% CI 0.54-0.73); intrathecal analgesia/anaesthesia (AOR 0.34; 99% CI 0.28-0.42); instrumental birth (AOR 0.80; 99% CI 0.69-0.93); caesarean section after labour (AOR 0.59; 99% CI 0.49-0.72) and admission to a neonatal unit (AOR 0.15; 99% CI 0.10-0.22) and for low risk multiparous women in hospitals with less than 100 births per annum: induction (AOR 0.69; 99% CI 0.62-0.76); intrathecal analgesia/anaesthesia (AOR 0.32; 99% CI 0.29-0.36); instrumental birth (AOR 0.52; 99% CI 0.41-0.67); caesarean section after labour (AOR 0.41; 99% CI 0.33-0.52); and admission to a neonatal unit (AOR 0.09; 99% CI 0.07-0.12). CONCLUSIONS: In Australia, lower hospital volume is not associated with adverse outcomes for low risk women.

Adult↗
PubMedDate not supplied

Mothers' satisfaction with their neonates' breastfeeding behaviors.

This study examined the relationship between breastfeeding competence in neonates and maternal satisfaction with breastfeeding during the early postpartum period. Mothers assessed their neonates' feeding behaviors and checked the satisfaction item on the study instrument at every feeding. Feeding scores and maternal scores were analyzed. The higher the neonate scored (i.e., the more effective the feeding), the more pleased the mother was with the feeding. Neonates of primiparous mothers had lower mean scores than neonates of multiparous mothers, and primiparous mothers were displeased with a higher percentage of feedings compared with the multiparous mothers (p less than .05).

Adolescent↗
PubMed2006

Uterine evaluation and gestation diagnosis in owl monkey (Aotus azarai infulatus) using the B mode ultrasound.

BACKGROUND: Gynecological and obstetrical ultrasonography has become an indispensable tool in the routine management, health evaluation and research on captive non-human primates. METHODS: Ultrasound was used to evaluate the uterus and estimate the gestation of owl monkeys. Twelve couples were selected, where five were primiparous and seven multiparous females from the National Primate Center reproductive colony, Ananindeua-PA, Brazil. The procedures were carried out using the GE Logiq 100 MP, equipped with a 7.5 MHz linear probe. RESULTS: The females showed a simple uterus, of elongated shape, regular outline and homogeneous echogenic texture. In the uterine measurements craniocaudal diameter, dorsoventral diameter and uterine volume (UV), significant differences were identified (P < 0.05) between ultrasound examinations of primiparous and multiparous females. The UV showed a positive correlation with the number of births. The gestational sac and the embryonic echo were visible between 28 and 38 days after mating. Between 48 and 68 days after mating, embryonic death was identified in all the gestations. CONCLUSIONS: The chemical (use of tranquilizers) and husbandry factors (capture stress) may be related to the prenatal death. The establishing methods of conditioning the female to the ultrasonographic exam may offer a solution to this problem.

Animals↗
PubMed1990

The detection of antibodies in pregnancy: a comparison of two assay systems.

In this study we have compared the ability of two assay systems, erythrocyte antibody rosette inhibition (EAI) and cellular enzyme-linked immunospecific assay (CELISA) to detect maternal alloantibody activity during pregnancy. Antibody activity to antigens on paternal lymphocytes was present in nine of 23 primigravid sera tested by EAI and in seven of 23 by CELISA. In multiparous sera, antibodies directed to paternal lymphocytes were detected in 11 of 15 individuals by EAI and in six of 15 by CELISA. The techniques correlated significantly when assaying the humoral response in sera from multiparous women. The lack of correlation when assaying primigravid sera suggests that both assays encounter difficulty in detecting the low titres of antibodies present.

Enzyme-Linked Immunosorbent Assay↗
PubMed1998

Peripheral blood mononuclear cells from women with recurrent abortion exhibit an aberrant reaction to release cytokines upon the direct contact of human leukocyte antigen-G-expressing cells.

PROBLEM: In search for pathogenesis of recurrent abortion, we examined whether lymphocytes/macrophages from women with recurrent abortion exhibited an aberrant ability to release cytokines upon the direct contact of human leukocyte antigen (HLA)-G. METHOD OF STUDY: The amounts of cytokines released from peripheral blood mononuclear cells (PBMCs) from women with recurrent abortion were compared with those from normal multiparous women or normal nulligravidous women when cocultured with or without HLA-G-expressing target cells. RESULTS: When cocultured with HLA-G-expressing target cells, the amount of interleukin-1 beta released from PBMCs was increased in recurrent aborters whereas it decreased in both normal multiparous and nulligravidous women. The amount of interleukin-3 released from PBMCs did not differ with or without HLA-G-expressing cells in recurrent aborters, whereas it increased in the presence of HLA-G-expressing cells in normal controls. The amount of tumor necrosis factor-alpha released from PBMCs was decreased in the presence of HLA-G-expressing cells in both recurrent aborters and normal controls. CONCLUSION: The aberrant reaction of maternal lymphocytes/macrophages in releasing cytokines upon the contact of HLA-G expressed on trophoblasts may impact negatively on trophoblastic growth, which may be pathogenic in recurrent abortion.

Abortion, Habitual↗