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Volvulus of the spleen in absence of malarious splenomegaly is rare. Most reported instances occur in young and middle-aged women and are related to a congenital abnormality of the mesogastrium, pregnancy, and multiparity. In this reported case of splenic volvulus in a young, multiparous woman, posterior mesogastrium malformation was the cause. Certain preoperative findings could suggest this infrequent diagnosis in future cases.
The role of physical factors in the severity of labour pain has been neglected. The amount of cervical dilation, the frequency of the contractions, the woman's height and usual weight before the pregnancy and other physical factors were therefore examined in relation to the intensity of labour pain in 141 primiparous and 99 multiparous women. In general, pain increased gradually during labour in both groups of women, though the severity of the pain was lower in the women who had received prepared childbirth training than in those who had not. Although the average pain scores in this study were high, there were striking individual differences, some women having extremely severe pain and others having almost none. The pain scores in both groups of women were significantly correlated with the ratios of the women's usual weight to height. In the multiparous women the scores were also correlated with the woman's usual weight and the baby's weight but not with the woman's weight gain during pregnancy. Thus, the results show that physical as well as psychologic factors contribute to the severity of labour pain.
Feeding of retinyl acetate (82 mg/kg ration) for 13-16 weeks to estrone- and progesterone-treated nulliparous and multiparous inbred GR/A mice resulted in a substantial increase in the incidence of mammary carcinomas. Mammary carcinoma incidence in nulliparous control and retinoid-fed mice in experiment #1 was 22/65 (34%) and 37/65 (57%) (P less than 0.05), respectively; in experiment #2, 27/48 (56%) and 37/48 (77%) (P less than 0.05), respectively. Mammary carcinoma incidence in multiparous control and retinoid-fed mice in experiment #1 was 13/30 (43%) and 23/30 (77%) (P less than 0.05), respectively; in experiment #2, 19/19 (100%) and 19/19 (100%), respectively. The purported chemopreventive activities of retinyl acetate in murine mammary tumorigenesis were not demonstrated in this study; indeed, the vitamin A analog appeared to enhance this oncogenic process in the steroid hormone-treated GR mouse mammary cancer model.
Uterine rupture is an uncommon complication of midtrimester abortion, occurring more frequently in the older multiparous patient and with the use of high doses of oxytocic agents. The clinical presentation may vary from an unexplained drop in the hematocrit or persistent abdominal pain to profound shock and maternal death. There is often considerable delay in diagnosis and subsequent treatment. The clinical presentation of a patient who sustained uterine rupture during midtrimester abortion is described and the possible etiology, clinical presentation, and management of this condition are described. It is recommended that older multiparous patients receiving oxytocic agents be monitored closely to prevent uterine hyperstimulation and that prompt laparotomy be performed when the diagnosis of uterine rupture is made.
The popliteal lymph node (PLN) assay for graft versus host (GVH) reactivity has been used to analyse specific features associated with the immunological aspects of the materno-fetal relationship. GVH responses induced following the injection of maternal lymphocytes into F1 hybrid recipients is a particularly relevant model for testing the cellular reactivity of maternal lymphocytes against F1 hybrid determinants since every allogeneic pregnancy could initiate a naturally occurring mother versus F1 allograft reaction. Experiments monitored sequentially the effects of the pregnancy environment and multiparity on maternal cell-mediated immunity. The PLN assay performed within the confines of pregnant F1 hosts indicated that GVH reactivity was significantly suppressed during the mid and late stages of gestation with suppression being greatest in allogeneic combinations. In addition cells obtained from pregnant donors were less efficient than normal cells at GVH induction when transferred to virgin F1 recipients. The suppressive effect was maximal at mid-gestation; however, in this situation, the genotype of the paternal strain had no significant effect on the degree of immunosuppression observed. Multiparity in allogeneic combinations induced anti-paternal humoral immunity but an equivalent increase in GVH reactivity was not detected. These results support the concept of pregnancy-associated suppression of cell-mediated immunity. The nature of the suppressive effect is discussed.
To test the hypothesis that intrahepatic cholestasis of pregnancy represent an abnormal reaction to estrogens in genetically predisposed individuals, the sulfobromophthalein disappearance curve from blood was compared before and after ethinyl estradiol administration (0.1 mg/day, during 6 days) in multiparous women with or without a past history of intrahepatic cholestasis of pregnancy, and in nulliparous women and men with or without a familial history of the disease. BSP concentration in blood, from 5 to 65 min after a single i.v. injection of the dye (5 mg/kg body wt), was fitted into biexponential curves using a computerized program. Ethinyl estradiol administration decreased the slope of the second component of the curve (k2) in most subjects and in both sexes. This effect was greater in multiparous women with a past history of intrahepatic cholestasis of pregnancy than in their controls. An exaggerated response to ethinyl estradiol was more frequently found in nulliparous women, and in men, with a familial history of the disease than in those without it. These observations suggest the presence of a constitutional abnormality in the metabolic interactions between estrogens and the liver, independent from pregnancy itself. This abnormality could be genetically transmitted by individuals from either sex, determining a predisposition to develop intrahepatic cholestasis of pregnancy in their female descendants.
A normovolemic pulmonary edema associated with blood transfusion developed in a 38-year-old woman during gynecological operation. Bilateral pulmonary infiltrates and profound leucopenia (700.microliters-1) were observed. An antibody reactive with the recipient's neutrophils was found in a donor and an antibody reacting with the lymphocytes of the recipient was identified in another donor. Both donors were multiparous women. Respiratory failure was improved with mechanical ventilation but chest X-ray showed pulmonary infiltrates for the next 3 days. The white blood cell count rose to 2900.microliters-1 in the next day, and it took 2 weeks to be normalized. Transient pulmonary infiltrates can be caused by antileukocyte antibodies passively transfused by multiparous donors.
INTRODUCTION AND OBJECTIVES: Diabetic Pregnancy Prognosis in Seventies is it better in Eighties because of Patient Education? METHODOLOGY: Retrospectively, since 1980 to 1989, in Women in status to breed, Diabetic Pregnancy was screened in our Department. W.H.O.'s (1980) Diabetes Mellitus Criterias, PEDERSEN's Criterias, White's Classification were used. Studied Parameters were etiologic factors (age, type, Diabetes oldness and control), former and present Evolution of Pregnancies (term and pregnancy's product). RESULTS: A--In Global Study, 15.07% Diabetic Pregnancies were observed: 22 (37%) Insulin Dependent and 38 (63%) Non Insulin Dependent. The global mean of age was 31 years; Diabetic Mellitus was less than 10 years old in 90% cases whatever the type. Their control was not good (Glycemic Control < 1.4 g/l in less than 50%). Diabetes complications were nephropathy (13.6% and 8%), retinopathy (13.6% and 18.5%), arterial hypertension (0% and 26.32%), cetoacidosis (31.42% and 0%), urinary tract infection (18% and 0%) respectively in Insulin Dependent and Non Insulin Dependent Pregnancies. Near a third (31.6%) of Insulin Dependent and a third (33.41%) for Non Insulin Dependent were of D, F, H White's Class. Multipares were often Non Insulin Dependent and inversely Insulin Dependent frequently paucipare. Former Pregnancies had near 25.5% interrupted term in Insulin Dependents. Present Pregnancies have given 28.5% and 32% of Normal Children: 14.25 and 12% of Abortions and 14.25% and 6% of Spontaneous Premature Parturitions respectively in Insulin Dependents and Non Insulin Dependents. B--In Analytic Study of Foetopathies, bad Prognosis Factors were high Maternal Age, Multiparity, bad Glycemic Control whatever Diabetes type. For Insulin Dependent, Negligency was added and for Non Insulin Dependent, Obesity, Arterial Hypertension and all PBSP. DISCUSSION AND CONCLUSION: A relatively mild Diabetic Pregnancy Prognosis in our areas with limited means has been observed despite of Patients Education.
We have compared effects of epidural analgesia in labour in two groups containing 35 primiparous each and in two groups containing 35 multiparous each. We have administered either bupivacaine or bupivacaine with fentanyl. We have compared duration of the 1-st and the 2-nd stage labour, efficiency of analgesia, quantity of administered bupivacaine, method of delivery and condition of the newborn. This investigation has shown that use of 0.25% bupivacaine with fentanyl requires less quantity of bupivacaine in both groups of primiparous and multiparous. The addition of fentanyl to 0.25% bupivacaine can be beneficial alternative of epidural analgesia in labour.
The study concerned 664 women of South-West Finland, and they were studied 5-12 weeks after delivery. The total frequency of mastitis in this population was much higher than generally reported in literature, 24% as opposed to 3%. The frequency of mastitis was similar among nulli- and multiparous women. The diagnosis was based on the judgement of midwives of physicians. If a multiparous woman has had mastitis during a previous puerperium, the probability of mastitis during a subsequent puerperium is threefold. The type of skin, its reaction of the sun, allergies, rashes, getting cold and oxytocin medication during delivery did nto affect the incidence of mastitis. Mothers under 21 and over 35 years of age had a decreased incidence (P = 0.034) of mastitis. If the women had sore nipples, the frequency increased (P = 0.003). Prophylaxis, by means of physical training, neither decreased nor increased the frequency of puerperal mastitis. The treatment advised by midwives and physicians was primarily conservative, but 38% received antibiotics; some of the antibiotics were not effective against staphylococcal infection.
OBJECTIVE: To identify risk factors associated with severe preeclampsia and to determine whether these factors are similar in nulliparous and multiparous patients. METHODS: Patients whose pregnancies were complicated by severe preeclampsia (n = 70) were compared retrospectively to 18,964 non-preeclamptic controls. Information on maternal demographic factors; medical, obstetric, and family histories; and neonatal outcome was retrieved and analyzed by univariate and multivariate analysis. RESULTS: By logistic regression, the only risk factors associated with the development of severe preeclampsia were severe obesity in all patients (adjusted odds ratio 3.5, 95% confidence interval [CI] 1.68-7.46) and a history of preeclampsia in multiparous patients (adjusted odds ratio 7.2, 95% CI 2.74-18.74). CONCLUSION: Severe obesity and a history of preeclampsia are the only maternal risk factors identified for the development of severe preeclampsia.
Fifty cases of uterine rupture were managed in 4 years giving a frequency of 1 per 89.9 deliveries. There was an obvious difference between those with a previously scarred uterus (34) vs those without a scar (16) cephalopelvic disproportion, grand multiparity and mismanagement of cases by traditional birth attendant (TBAs) were the common etiologic factors in the unscarred uterus, cephalopelvic disproportion, forceps delivery, grand multiparity and prolonged first stage of labour were the common etiologic factors in patients with previously scarred uterus. In the unscarred group both maternal and foetal (81.6%) mortality was high (JPMA 43: 174, 1993).
AIM: To assess the adequacy of dietary intake of women during the three trimesters of pregnancy. METHOD: Dietary intakes of 63 primiparous and 32 multiparous healthy pregnant Dunedin women were obtained by 3 day weighed records at about 12 weeks, 24 weeks, and 36 weeks of gestation. Energy and nutrient intakes were derived using the University of Otago food composition database. RESULTS: Mean energy and nutrient intakes differed remarkably little between primiparous and multiparous women; data were combined for analysis. Energy intakes at first and second trimesters were similar to that for non pregnant women in the National Heart Foundation 1977 survey but greater than in the LINZ 1989 survey. Energy and carbohydrate intakes had increased at third trimester; across the trimesters carbohydrate accounted for 44-46% energy intake, fat for 39% and protein for 15%. Protein intakes at the 10th centile were almost the same as the recommended low risk intake of 51 g/d set by WHO/FAO: No vitamin or mineral showed a trend in intake through the trimesters. Vitamin and mineral intakes were in general greater for the pregnant women than for nonpregnant women in both 1977 and 1989 studies. By comparison with recommended intakes for NZ, Australia, USA and UK, intakes for folate, vitamin B-6, iron and possibly zinc and thiamin were potentially inadequate. Over 10% were heavy smokers and 20% were light smokers; nutrient intakes were less for the smokers than for the nonsmokers, as were birth weights; energy intakes for smokers had not increased at the third trimester. CONCLUSION: An improvement in quality of diet is needed during pregnancy and in prenatal period; smoking should continue to be strongly discouraged.
The present experiment was undertaken to verify if the demand of tissues for pteroylglutamic (folic) acid, evaluated by serum clearance and urinary excretion of folates, is different between multiparous dairy cows in late gestation (five gestating dry cows, 52.6 (SD 8.4) d before parturition), and in early lactation (four lactating non-gestating cows, 18.0 (SD 5.9) d after parturition). On day 1 the cows received one intravenous (i.v.) injection of 50 micrograms pteroylmonoglutamic acid/kg body weight (BW). Blood samples were taken at 0, 5, 15, 30 min, 1, 2, 4, 8 and 24 h after the i.v. injection. On day 3 the cows received one intramuscular (i.m.) injection of 0.3 mg pteroylmonoglutamic acid/kg BW. Blood and urine samples, as well as urine volume, were taken at 0, 1, 2, 4, 8, 12, 24, 36 and 48 h after the i.m. injection. On days 5, 6 and 7 a daily i.m. injection of 0.5 mg pteroylmonoglutamic acid/kg BW was given in an attempt to saturate tissues with folates. Then the cows received one i.v. (day 8) and one i.m. (day 10) injection of pteroylmonoglutamic acid according to the same procedures described previously for days 1 and 3. On day 12 plasma volume was determined. Before tissue saturation, serum clearance of folates during the 24 h following an i.v. injection was similar for gestating and lactating cows but after tissue saturation serum clearance was slower for lactating than gestating cows (stage x saturation, P = 0.04). The percentage of folates excreted in urine was not affected by the physiological stage (P > or = 0.6) or the level of tissue saturation (P > or = 0.5). In conclusion, serum clearance and urinary excretion of pteroylmonoglutamic acid seem to support the hypothesis that, in multiparous cows, although there are no deficiency symptoms, tissue demand for folic acid is high, especially during gestation.
The phenomenon of foetal head descent and the effect of station of foetal head at admission on the course of labour were studied on the basis of a prospective partographic study in 100 cases of normal labour. Only 16.9% of nulliparous women had engaged foetal head at admission in labour. Engagement of foetal head occurred during the period of maximum slope of cervical dilatation in nulliparous women and at the onset of deceleration phase in multiparous women. Parturients with unengaged foetal head entered hospital much earlier in labour than those with engaged foetal based. Course of labour was uninfluenced by the degree of engagement of foetal head. However, multiparous women showed faster rate of foetal head descent than nulliparous women (p < 0.001) and women with lesser haemoglobin concentration demonstrated slower rate of descent of foetal head (p < 0.01).
Portal hypertension is a result of chronic liver disease in the majority of cases. Rare, potentially curable causes of portal hypertension include vascular conditions such as hepatic or portal venous thrombosis and arterio-portal fistulas. We present the rare case of a spontaneous splenic arterio-venous fistula in a 40 year old multiparous woman. The young woman presented with massive diarrhea, ascites, abdominal pain, and an abdominal machinery type bruit and represents the second ever reported case with diarrhea as presenting symptom of splenic arterio-venous fistula. The diagnosis was confirmed by color Doppler ultrasound. Transfemoral aortography was performed to assess the possibility of catheter embolization. Surgical intervention was initially complicated by collateral arterial tributaries of the fistula and finally resulted in a dramatic recovery with persistent resolution of all symptoms. This case report demonstrates a curable form of portal hypertension that must be considered in acute onset portal hypertension in multiparous women and in the absence of liver disease. A machinery type bruit in the upper left abdominal quadrant represents an important and simple diagnostic symptom found by auscultation. Color Doppler ultrasound represents a non invasive, universally applicable and fast method of establishing the diagnosis. The literature and management of splenic arterio-venous fistulas are reviewed.
Caesarean and vaginal deliveries of macrosomic infants weighing > or = 4500 g were studied, and pregnant women analysed by indication for caesarean section, presentation, parity and age. Both maternal and neonatal injuries occurred. Puerperal morbidity was noted in women delivered either by caesarean section or vaginally. The control group consisted of 321 parity- and age-matched pregnant women and their newborn infants weighing 3000-3499 g. The two groups were studied according to the same criteria. In the maternity unit of the General Hospital in Sibenik, Croatia, 10852 newborn infants were delivered (only singleton pregnancies included) between 1 January 1984 and 31 December 1993, of whom 321 (2.96%) weighed > or = 4500 g (290 weighing 4500-4999 g, and 31 weighing > or = 5000 g). Caesarean section was performed in 36 (11.2%) and 14 (4.4%) in the macrosomic and control groups, respectively (X2 = 10.50; P < 0.01). Of the 321 women with a macrosomic infant, 10 (3.1%) had a caesarean section for cephalopelvic disproportion and 7 (2.2%) for breech presentation. Caesarean section for vertex presentation was used more frequently in the macrosomic than in the control group (9.0% vs. 3.3%) (P < 0.01), as well as it was used for breech presentation (77.8% vs. 16.7%) (P < 0.01). As regards transverse and oblique lies, no difference was observed. The rates of macrosomic infants delivered from primiparous and grand multiparous women by caesarean section (i.e., 23.1% vs. 5.9% vs. 18.2%) were highly significant (X2 = 19.07; P < 0.001), as were the rates in adolescent pregnant women, in those of optimal childbearing age and in old pregnant women (60.0% vs. 9.0% vs. 26.9%) (X2 = 18.67; P < 0.001). Injuries were sustained by 28 (9.8%) women with a macrosomic infant delivered vaginally and by 12 (3.9%) controls (X2 = 6.25; P < 0.05). No maternal injuries were reported with caesarean delivery in either group. There was no birth trauma in the macrosomic and control infants delivered by caesarean section. With vaginal delivery birth trauma involved clavicular fracture (5.6%), brachial plexus palsy (2.8%) and central nervous system syndrome (2.1%). A total of 30 (10.5%) macrosomic infants and 4 (1.3%) controls, were identified as having birth trauma (X2 = 20.99; P < 0.001). No difference in puerperal morbidity rates were observed between the two groups with regard to caesarean and vaginal delivery (P > 0.05), showing significantly lower rates for vaginally delivered macrosomic infants (12.3% vs. 30.6%) (X2 = 8.51; P < 0.01). There was no perinatal death among those delivered by caesarean section in either group; however, when delivered vaginally, the rates were 0.70% (2 of 285) and 0.65% (2 of 307) for the macrosomic and control infants, respectively (P > 0.05). No women in either the macrosomic or control group died. In conclusion, decision making on management options when delivering a macrosomic infant depends on fetal presentation and maternal age and parity. Vertex presenting macrosomic infants weighing > or = 4500 g should be delivered vaginally, but liberal judgement is suggested in resorting to caesarean section delivery. Abnormal presentation, as well as malpresentations in primiparous women, are an absolute indication for caesarean section, whereas malpresentations in multiparous women are a relative (underlying) indication for caesarean section.
Previous studies have suggested a positive correlation between grand multiparity and the incidence of Down syndrome (DS). In order to study different parities as risk factors for DS, the Swedish health registries were used, and 2,615 infants with Down syndrome were selected from 2,184,590 infants born in 1973-1993. A statistically significant risk decrease for primiparas, and a significant risk increase for grand multiparas (5+), was found (age-adjusted odds ratios: 0.87 (95% CI: 0.80-0.96) and 1.40 (95% CI: 1.18-1.65), respectively. Potential confounders, such as the effect of truncated maternal 1-year age classes, citizenship, socioeconomic level, etc., were evaluated but were found to have only marginal effects. Evidence suggesting that the extension of prenatal diagnosis during the study period has decreased the incidence of DS among women of parity 1-4, but not among women of parity 5+, was found. The hypothesis that Swedish grand multiparas may have another attitude toward prenatal diagnosis than women of lower parities was confirmed when, in a data set containing information on 872 amniocenteses, a significantly lower rate of grand multiparity than expected was found. For the negative association between primiparity and DS, no obvious confounder was found.