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PubMedDate not supplied

Introduction of partographic records in a District Hospital in Zambia and development of nomograms of cervical dilatation.

Partographic records of labour have been successfully introduced in a district hospital in Zambia. Nomograms of cervical dilatation show no significant difference compared to those obtained by other workers in other parts of the world. There was no difference in the duration of the active phase of the 1st stage of labour between multiparous patients (para 1--4) and grand multiparous patients (para greater than 4).

Cervix Uteri↗
PubMed1997

[Transfusion associated acute lung injury].

Transfusion associated acute lung injury (TRALI) is an infrequent but hazardous complication of transfusion. This syndrome is characterized by symptoms of acute respiratory distress and clinically evident noncardiogenic pulmonary edema. The occurrence of this entity is linked to the circulating leukoagglutinins. However many reports showed the incidence of this syndrome around 0.01% per unit transfusion, only three cases whose diagnosis were considered as TRALI were reported in Japan. It is because this syndrome was often misdiagnosed as other diseases, including cardiogenenic pulmonary edema or pneumonia. Some reports showed that the implicated donors were multiparous females. In an effort to prevent this syndrome, blood collection centers should limit component usage from multiparous donors to washed red cells.

Acute Disease↗
PubMed1997

High prevalence of cholelithiasis in a low income Mexican population: an ultrasonographic survey.

The authors present the results of a population-based survey of cholelithiasis carried out in a low-income area of Mexico City using high-resolution gallbladder ultrasound. The purpose of the study was to estimate the prevalence and selected associated risk factors of cholelithiasis (CL). The population of the studied area was 15,532 subjects, of whom 3,505 (22.6%) were eligible for the baseline survey (men and non-pregnant women between 35-64 years of age). Of this group, 1,735 (76.03%, 702 men and 1,033 women) were located for a follow-up study. Ultrasonography was performed on all except for 100 subjects who had undergone previous cholecystectomy. Crude prevalence of CL was 14.1% (95% CI 12.5-15.5). The prevalence was 5.8% (95% CI 4.1-7.5) in men and 19.7% (95% CI 17.3-22.1) in women. Presence of gallstones was associated with age, sex (men p<0.006, women p<0.001), and multiparity (p<0.002). Centrality index in men and body mass index in women were positive and significantly associated with CL when compared with subjects without CL. High levels of fasting and post-glucose load insulin in women and men respectively were associated with CL. The authors conclude that the population of this study has a high prevalence of CL and confirm some known risk factors such as age, sex, BMI and multiparity. Proper assessment of the magnitude problem and characterization of potentially modifiable risk factors will play a major role in preventing this pathology.

Adult↗
PubMed1998

Importance of mother/young contact at parturition and across lactation for the expression of maternal behavior in rabbits.

We prevented mother/pup contact at parturition or across early or midlactation to investigate the importance of such interaction for maintaining material behavior in rabbits. When pup contact was prevented across lactation Days 1-7 or 11-17 (by anesthetizing multiparous mothers during the oxytocin-induced milk letdown; Experiment 1), nursing incidence was reduced to 40% and 83%, respectively, on the day following anesthesia withdrawal. Both groups also showed a decreased milk output, long latencies to initiate nursing, and several entrances into the nest box not associated with nursing. In Experiment 2 we prevented mother/litter contact at parturition to determine the specific role of pup contact at this time. We found a reduction in the incidence of nursing on postpartum Day 1 from 80% (in control primiparous mothers) to 33%. By contrast, 100% of both deprived and control multiparous mothers displayed nursing on Day 1. These mothers also showed the unusual behaviors found in Experiment 1 and an extemporaneous nest-building. We conclude that: (a) mother/young contact at parturition is crucial for establishing maternal responsiveness in primiparous does, (b) the experience acquired by raising a previous litter allows the retention of maternal responsiveness despite a lack of pup contact at parturition, (c) maternal responsiveness is maintained across early lactation by daily interaction with pups, and (d) interaction with pups across midlactation allows the finely tuned display of maternal behavior.

Animals↗
PubMed1998

[Breech presentation: management (304 cases)].

UNLABELLED: BUT: Try to precise the optimal management in 1997 face a breech presentation. METHOD: Between January 1991 and December 1995, 304 cases of breech presentations were listed at the maternity of Pavillon Victor Olivier (Lille). From these 304 breech presentations, all parities blended, the authors have analysed the mode of delivery of these patients, distinguishing the para one from the multiparous women and the preterm babies from the other babies. From this study and a review of the literature, were discussed the criterions which can help the practitioner to determine the mode of delivery of these fetus. RESULTS: The results show a cesarean section (cs) rate of 51% (41% of first intention cs and 10% of second intention cs were realized only for primiparity + breech presentation and 67% of the para one women benefited from a first intention cs 8.72% of vaginal deliveries were complicated, and 5 fetal injuries were noted without sequel. On 296 live new-borns, only 2 cases of fetal death were perhaps due to the vaginal delivery. Fetal mortality is principally reliable at the prematurity and the congenital malformations, but finally, not due to mode of delivery. CONCLUSION: The difficulty is to determine rigorous criterions of selection to authorize a vaginal delivery without spoil the fetal pronostic. The major criterions are a perfect radiopelvimetry, an estimated fetal weight < 3800 g for the para one women and < 4300 g for the multiparous woman, a well flexed fetal head, favorable obstetric conditions ond the absence of maternal or fetal complications. The primiparity is not an indication of systematic cesariean section.

Breech Presentation↗
PubMed1976

Hormone release and abortifacient effectiveness of a newly developed silastic device containing 15-ME-PGF2alpha methyl ester in concentrations of 0.5% and 1.0%.

Abortion was successfully induced by intravaginal administration of a newly developed silastic device impregnated with 15(S)-15-methyl-prostaglandin F2alpha methyl ester in a concentration of 0.5% in 26 of 35 women in the 12th to the 24th weeks of gestation and by prostaglandin with concomitant oxytocin infusion in an additional 5 patients. A second comparable group of 35 women, with gestational ages from 9 to 23 weeks, received a silastic device with a concentration of 1.0% of the prostaglandin. Twenty-six women in the second group aborted with prostaglandin alone and an additional 6 patients aborted with combined prostaglandin-oxytocin therapy. Seven patients of the 70 included in this study failed to abort with intravaginal administration of 15-ME-PGF2alpha methyl ester even with concomitant oxytocin therapy; this group included 4 patients receiving the 0.5% device and 3 patients with the 1.0% device. The mean abortion time for the 31 successful abortions with 0.5% device was 15.15 hours and multiparous patients aborted in a mean time of 9.69 hours, significantly faster than the nulliparous patients, mean time 18.49 hours. The mean abortion time for the 32 successful abortions with the 1.0% device was 15.61 hours and there was no significant difference in the mean abortion times between nulliparous and multiparous patients in this group. No significant difference could be demonstrated between the mean abortion times of patients receiving an 0.5% concentrations of prostaglandin and patients receiving a 1.0% concentration of the drug. In both groups more than 40% of the patients had aborted within 12 hours of the insertion of the prostaglandin device and more than 80% had aborted within 24 hours. The intravaginal device appeared to be effective in inducing abortion throughout the gestational ages tested in this series. Peripheral plasma levels of 15-ME-PGF2alpha were analyzed in 15 patients with the 0.5% device and 8 patients with the 1.0% device. In patients with the 0.5% device the mean plasma concentration of prostaglandin peaked 2 hours after insertion, while in patients with the 1.0% device the peak was achieved within 15 minutes of insertion followed by a rapid decline in plasma prostaglandin levels. Diarrhea was the most frequent side effect related to the intravaginal administration of the prostaglandin, and in this series the severity of this gastro-intestinal disturbance appeared to be significantly higher in patients receiving the 1.0% device.

Abortion, Induced↗
PubMed1998

Survivors of sexual abuse: clinical, lifestyle and reproductive consequences.

BACKGROUND: In recent years, an increase in the prevalence of sexual abuse of women has been reported in Canada and elsewhere. However, there are few empirical data on the extent of the problem in Canadian aboriginal populations. The authors investigated the presence of a reported history of sexual abuse and other health determinants in a sample of women attending a community health centre with a substantial aboriginal population. This allowed determination of whether reported sexual abuse and its associated demographic and health-related effects were different for aboriginal and non-aboriginal women. METHODS: A sample of 1696 women was selected from women attending a community health centre in a predominantly low-income inner-city area of Winnipeg for a cross-sectional survey designed to study the association between sexual behavior and cervical infections. The survey was conducted between November 1992 and March 1995 and involved a clinical examination, laboratory tests and an interviewer-administered questionnaire. A substudy was conducted among 1003 women who were asked 2 questions about sexual abuse. RESULTS: The overall response rate for the main study was 87%. Of the 1003 women who were asked the questions about sexual abuse, 843 (84.0%) responded. Among the respondents, 368 (43.6%) were aboriginal. Overall, 308 (36.5%) of the respondents reported having been sexually abused, 74.0% of the incidents having occurred during childhood. The prevalence was higher among aboriginal women than among non-aboriginal women (44.8% v. 30.1%, p < 0.001). Women who had been sexually abused were younger when they first had sexual intercourse, they had multiple partners, and they had a history of sexually transmitted diseases. In addition, non-aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have had abnormal Papanicolaou smears. The proportion of smokers was higher among the abused women than among the non-abused women in both ethnic groups. INTERPRETATION: A history of sexual abuse was associated with other clinical, lifestyle and reproductive factors. This suggests that sexual abuse may be associated with subsequent health behaviors, beyond specific physical and psychosocial disorders. Aboriginal and non-aboriginal women who have suffered sexual abuse showed substantial differences in their subsequent health and health-related behaviours.

Adult↗
PubMed1998

Effect of age and parity on primary caesarean section rates.

OBJECTIVE: To study the effect of maternal age and parity on the rates of primary caesarean section. METHOD: We reviewed all patients who delivered at the Princess Badeea Teaching Hospital between 1 January, 1995 and 26 November, 1995. RESULTS: There were 8,732 deliveries included in this study. The primary caesarean section rates in primiparous women less than 25, 25 to 34 and over 34 years of age were 6.1%, 11.1% and 22.2%, respectively. A similarly dramatic rise with advancing maternal age was seen in multiparous women with rates of 3.1%, 6.4% and 9.5%, respectively, in the three age groups. A strong association between maternal age and primary caesarean section exists (p < 0.05). Caesarean section rates in the primiparous women were higher in all age groups when compared with multiparous women (p < 0.0001). CONCLUSIONS: Increasing maternal age and parity are factors strongly associated with increased primary caesarean section rates.

Adult↗
PubMed1998

Parity as a risk factor for cancer cervix.

The present hospital based, group matched case control study was carried out at Gynecology Clinic, Govt. Medical College hospital, Nagpur, to investigate role of parity in the outcome of cancer cervix. The study included 230 cases of cancer cervix and equal number of controls, matched for age. The study identified significance of multiparity, as a risk factor for cancer cervix. Estimates of attributable risk proportion (ARP) and population attributable risk proportion (PARP) endorsed etiological and preventable role of multiparity in the outcome of cervical cancer, respectively.

Adolescent↗
PubMedDate not supplied

Calculated milk production losses associated with elevated somatic cell counts in dairy cows: review and critical discussion.

Relationships between somatic cell count (SCC) and variation in milk production at the cow level were reviewed to provide average reference values suitable for the assessment of economic losses due to subclinical mastitis. The literature analysis involved 19 papers, defining milk yield and/or its composition either at test-day level or at the whole lactation level as statistical unit. Within each type of approach, study populations and designs differed. Regression models implemented also showed large differences. At test-day level, the average trend was a loss of 0.4 kg of milk in primiparous cows and 0.6 kg in multiparous, by each 2-fold increase of SCC above 50,000 cells/mL. At the lactation level, the average trend was a loss of 80 kg of milk in primiparous and 120 kg in multiparous, by each 2-fold increase of the geometric mean of SCC above 50,000 cells/mL. Protein content of milk showed a small increase of 0.15 g/kg (at the test-day level) while fat content showed a small decrease of 0.20 g/kg (both at the test-day and at the lactation level), by each 2-fold increase of SCC. The value of further studies was underlined, especially to provide more accurate quantification of the composition changes associated with elevated SCC, and to improve the imperfect knowledge about the effects of parity and stage of lactation on the studied relationships.

Animals↗
PubMed1984

The effect of maternal age, parity, and prenatal care on perinatal outcome in adolescent mothers.

Maternal age and prenatal care were found to influence the risk for having a small-for-gestational age infant in white adolescent mothers who had both one and two previous live births. However, poor care exerted a relatively stronger affect than young age for primiparous mothers, while the reverse was found for multiparous mothers. Moreover, for women with first births, there was an interaction between variables in that early prenatal care promoted better pregnancy outcome for younger teenagers than for older teens or adults. These results indicate that the perinatal risks of adolescent pregnancy are affected by both physiologic factors and prenatal care.

Adolescent↗
PubMed1980

Levels of HCG in subjects using the Progestasert(TM) intrauterine progesterone systems.

Twelve subjects using the intrauterine progesterone system were followed during 4 consecutive menstrual cycles for FSH, LH, hCG and progesterone levels. They were all multiparous, with documented ovulation and sexually active even during the ovulatory period. With the exception of one case which became pregnant, there was no evidence for the presence of hCG during the period of observation. This data, even if preliminary, suggest that the Progestasert(TM) exerts a contraceptive action which differs from that of other devices, whether medicated or not, and that, such action occurs at a stage early enough to prevent the formation of hCG.

Adult↗
PubMed1975

Midtrimester abortion induced by serial intravaginal administration of prostaglandin E2 suppositories in conjunction with a contraceptive diaphragm.

Midtrimester abortion was successfully induced in 68 of 69 patients with serial intravaginal administration of prostaglandin E2 suppositories behind a contraceptive diaphragm. The mean abortion time for the successful inductions was 13.07 hours; multiparous patients aborted somewhat faster, mean 12.72 hours, as compared to nulliparous patients, mean 14.22 hours. In 36 patients the PGE2 suppositories were placed behind an intact diaphragm and the mean abortion time was 14.89 hours. In 33 patients the PGE2 suppositories were placed behind a diaphragm modified by having an opening incised in the center, the mean time in these patients was 11.96 hours. Of the 68 successful abortions 59% of the patients aborted in 12 hours or less and 88% aborted within 24 hours. The most frequently encountered side effect was temperature elevation of 2 degrees F or higher which occurred in 68% of the patients. Temperatures returned to normal levels within 4 to 6 hours after the last adminstration of PGE2. Gastrointestinal side effects occurred in 45% of patients, but these side effects were well tolerated and did not require termination of drug administration in any of the patients. Intravaginal administration of PGE2 suppositories is a very effective abortifacient technque during the midtrimester, however the use of PGE2 in conjunction with a diaphragm did not appreciabley improve the technique although the amount of drug administered and the incidence of side effects was somewhat lower than when the PGE2 suppositories are used alone. If a diaphragm is to be used, a modified diaphragm is indicated since it simplifies the clinical management of the abortion, eases administration of the suppositories and permits a more accurate estimation of cervical changes, vaginal bleeding and abortion.

Abortion, Induced↗
PubMed1990

Repeat adolescent pregnancy and low birth weight: methods issues.

Longitudinal studies of the relationship between birth order and birth weight suggest that mean birth weight increases with parity among women of all ages. In contrast, national birth statistics and other cross-sectional studies of these relationships suggests a decrease in mean birth weight and an increased incidence of low-weight births with parity among adolescent mothers. We examine the potential reasons for these strikingly different conclusions. Our aim is to determine whether multiparity itself is a low-birth-weight risk factor among adolescent mothers or whether it is a marker for other adolescent maternal conditions that increase the risk of a low birth weight, independent of parity.

Adolescent↗
PubMed1982

The technique for human embryo transfer.

In a program of human in vitro fertilization (IVF), the results of 204 attempted intracervical embryo transfers (ETs), using a variety of catheters in three trials over 18 months, have been analyzed for the ease of transfer and pregnancy rate. In nulliparous patients, transfers were more difficult than in multiparous patients; and a closed-end Teflon catheter was found to be more easily passed through the smaller cervical canal than an open-end catheter. The overall pregnancy rate was 17% (March 1980 to August 1981) and was not related to catheter type, although when chemical pregnancies were excluded, it was found that transfers using open-end catheters were more successful. The transfer procedure developed finally for routine use incorporates a consideration of these results.

Embryo Transfer↗
PubMed1984

A comparative study of the follicular growth profile in conception and nonconception cycles.

To study the follicular growth profile of normal women, 25 multiparous volunteers were assessed daily by ultrasound to measure the growing follicle and underwent venipuncture daily for detection of the luteinizing hormone (LH) peak. Eleven subjects conceived during the first cycle, 1 during the second cycle, and 1 during the third cycle. The 15 cycles where conception was not achieved showed unequivocal signs of ovulation (i.e., an LH peak and progesterone concentrations in the luteal phase greater than 20 nM/l). The mean prerupture follicular diameter was not significantly different in either group, 19.65 mm and 19.1 mm, respectively; however, the growth profile showed marked differences with a stabilization of follicular growth 24 hours prior to rupture in all patients in the conception group. On the other hand, the LH peak occurred within the 24 hours immediately preceding follicular rupture in the conception cycles; whereas in the nonconception group, this time interval extended up to 48 hours prior to rupture.

Adult↗
PubMed1998

Estonian medical birth registry 1992-1994: association of risk factors with perinatal mortality.

OBJECTIVE: To investigate the association of different maternal sociodemographic characteristics and infant sex with perinatal mortality among primiparas and multiparas. STUDY DESIGN: Analysis of routine data from the Estonian Medical Birth Registry covering the whole of Estonia. A total of 47 358 infants (including stillborns) with a birth weight 1000 g or more from 1992 through 1994 were studied. Perinatal mortality rate, crude odds ratio (OR) and adjusted OR (calculated by a logistic regression model) were used to evaluate the association. OR values were adjusted for maternal age at delivery, maternal ethnicity, educational level, residence, marital status, smoking status, history of previous abortion and infant sex. RESULTS: The perinatal mortality rate was 12.2 per 1000 total births among primiparous and 14.3 among multiparous women. The highest adjusted ORs of perinatal deaths were found in older (35 years and over) primiparas (1.78; 95% confidence interval (CI 0.88-3.57)) and multiparas (1.81; 95% CI 1.29-2.55), in unmarried (single) primiparas (1.59; 95% CI 1.14-2.20) and multiparas (1.98; 95% CI 1.29-3.05), in smoking primiparas (1.69; 95% CI 1.09-2.63) and multiparas (1.51; 95% CI 1.02-2.25), and in multiparas with unknown smoking status (1.98; 95% CI 1.18-3.33). CONCLUSION: The study provides further evidence that perinatal mortality is positively associated with increased maternal age, unmarried (single) status and smoking.

Adult↗
PubMed1976

Menopausal estrogens and breast cancer.

1891 women given conjugated estrogens for the menopause were followed for 12 years (mean) for incidence of breast cancer. Overall, 49 cases were observed; 39.1 were expected on the basis of rates in the general population (relative risk = 1.3, P = 0.06). The relative risk increased with follow-up duration, progressing to 2.0 after 15 years (13/6.6, P = 0.01). The excess risk after 10 years was not due simply to prolonged estrogen use, since there was no clear dose-response relation to accumulated years of use. However, higher risk accrued to women using higher-dose tablets and those taking the medication on an other than daily basis. In addition, after 10 years of follow-up observation, two factors related to low risk of breast cancer, multiparity and oophorectomy, were no longer so related. Finally, estrogen use was related to an especially high risk of breast cancer among women in whom benign disease developed after they had started the drug.

Aged↗