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PubMed2006

Comparison of labor progression between induced and noninduced multiparous women.

OBJECTIVE: The incidence of labor induction is rising rapidly in the United States. Among multiparas, labor is often followed with traditional labor curves derived from noninduced pregnancies. We sought to determine how labor progression of multiparous women who presented in spontaneous labor differed from those who were electively induced with and from those induced without preinduction cervical ripening. METHODS: We analyzed data on all low-risk multiparous women with an elective induction or spontaneous onset of labor between 37(+0) and 40(+6) weeks of gestation from January 2002 to March 2004 at a single institution. The median duration of labor by each centimeter of cervical dilatation and the risk of cesarean delivery were computed for 61 women with preinduction cervical ripening and oxytocin induction, 735 women with oxytocin induction, and 1,885 women with a spontaneous onset of labor. An intracervical Foley catheter was used to ripen the cervix. RESULTS: Those women who experienced electively induced labor without cervical ripening had a shorter active phase of labor than did those admitted in spontaneous labor (99 minutes in induced labor versus 161 minutes in spontaneous labor, P < .001). However, the cesarean delivery rate was elevated in the induction group (3.9% versus 2.3%, P < .05). Women who underwent preinduction cervical ripening also had a shorter active phase than those admitted in spontaneous labor (109 minutes versus 161 minutes, P = .01). CONCLUSION: The pattern of labor progression differs for women with an electively induced labor without cervical ripening compared with those who present with spontaneous onset of labor.

Adult↗
PubMed1993

Limiting dilution analysis of the allo-MHC anti-paternal cytotoxic T cell response. I: Normal primigravid and multiparous pregnancies.

Anti-paternal cytotoxic T lymphocyte precursor frequencies (CTLpF) were determined by limiting dilution analysis (LDA) in the peripheral blood of eight primigravid and seven multiparous women during the three trimesters of pregnancy. In five of these women the responses to cord blood lymphocytes (CBL) and paternal lymphocytes were also determined at the time of delivery and at 6 weeks post delivery. As controls, CTLpF against unrelated third party donors were determined. A wide range of CTLpF against all three groups of targets was found in both the primigravid and multiparous women, reflecting the wide range of frequencies found in random populations. These frequencies remained fairly constant during and 6 weeks after the pregnancy. Splitwell analysis demonstrated that the responses generated in our culture system were specific to the stimulator. The LDA data conform to single-hit kinetics, indicating that only cytotoxic T cells were limiting in the assay. Proliferative responses of maternal lymphocytes to paternal, cord blood and third party MHC antigens also remained unchanged as determined by time-course mixed lymphocyte reactions (MLR). Our data suggest that there is no significant allo-stimulation or suppression of the maternal immune system during normal pregnancy. The mother remains immunocompetent and is capable of both cytotoxic and proliferative responses to paternally-derived fetal MHC antigens. Our findings confirm that in normal pregnancy the trophoblast, which is devoid of classical MHC antigens, forms an effective immune barrier which prevents interaction of the maternal and fetal immune systems.

Cells, Cultured↗
PubMed1996

Multiparity and bone mass.

OBJECTIVE: To investigate the influence of multiparity on bone mass of the axial skeleton in a population of women of high parity. DESIGN: Open study of Omani women. SETTING: Medical physics department and clinical physiology department of a third degree referral (university) hospital. PARTICIPANTS: A consecutive series of 159 normal women referred with low back pain over a period of six months. RESULTS: The bone mineral density was measured with dual-photon absorptiometry and the mean was found to be 0.984 (+/-0.166) (+/- SD) g cm-2. The age ranged from 20 to 70 years with a mean age of 43.4 (+/- 12.5) years. The number of children per woman ranged from 0 to 14 with a mean of 5.1 (+/- 3.5). There was no statistically significant influence of the number of children per woman on bone mineral density but there was a strong correlation with age and body size variables. CONCLUSION: Multiparity does not influence lumbar spine bone mineral density in normal women.

Absorptiometry, Photon↗
PubMed2001

Effect of the supine position on uterine and umbilical blood flow during the third trimester of uncomplicated pregnancies in multiparous patients.

We established the effects of the supine position on umbilical blood flow when measured during the third trimester in 30 multiparous, normotensive patients. Blood flow in the umbilical and uterine arteries and blood pressure in the brachial and popliteal arteries were blindly taken by two different observers: first in the lateral and 5 min later in the supine position. There was a significant difference in mean blood pressure between the two postures. However, there was no statistical difference in the pulse pressure or in systolic/diastolic ratio in the umbilical and uterine arteries between the two positions. Postural changes in normotensive multiparous patients do not affect uterine and umbilical blood flow during the third trimester of uncomplicated pregnancies.

Adult↗
PubMed2002

Induction of labor in grand multiparous women and previous cesarean section: is it safe?

OBJECTIVE: To compare the outcome of induced and spontaneous labor in grand multiparous women with one previous lower segment cesarean section, so that the safety of labor induction could be assessed. METHOD: In 56 women labor was induced and their outcomes were compared with those of 177 women with spontaneous labor. All women were multiparous and had had one previous cesarean section. RESULTS: There were no significant differences in the incidences of 1- and 5-min Apgar scores, congenital malformation, cesarean section rates and uterine scar dehiscence or uterine rupture. There were 4 cases of intrauterine fetal death in the induction group, but no case of intrapartum or early neonatal death in the 2 groups. In the study group, 80.4% of the women delivered vaginally compared with 84.3% in the control group. CONCLUSION: In this moderate-sized study, we may conclude that when there is no absolute indication for repeating cesarean section, induction of labor may be a safe option in these high-risk women.

Adult↗
PubMed1977

Seasonal variations in post-partum plasma progesterone levels and conception in primiparous and multiparous dairy cows.

Progesterone concentrations in peripheral plasma of 18 primiparous and 34 multiparous dairy cows were determined by radioimmunoassay every 4 days, from 10 days post partum until the next conception. The interval from parturition to the first progesterone peak (greater than 4 ng/ml plasma) was significantly longer (P less than 4 ng/ml plasma) was significantly longer (P less than 0.01) in primiparous than in multiparous cows. The progesterone concentrations on Days 4-15 of the oestrous cycle were significantly lower (P less than 0.025) during the summer than in cycles occurring in winter. The conception rate during the summer was lower than in winter. In cows inseminated in summer, conception was related to the shape of the progesterone curve in the cycle preceding insemination.

Animals↗
PubMed1996

MR imaging of the anal sphincter in multiparous women using an endoanal coil: correlation with in vitro anatomy and appearances in fecal incontinence.

OBJECTIVE: The aim of this study was to correlate the components of the normal female anal sphincter seen on high-resolution MR images with the in vitro anatomy and to describe the change in appearances of these components in multiparous women with fecal incontinence. SUBJECTS AND METHODS: Ten asymptomatic female volunteers (32-72 years old; mean, 54 years old) and 22 women with fecal incontinence were studied. In six patients (26-68 years old; mean, 49 years old) fecal incontinence began immediately after childbirth; in the remaining 16 patients (45-77 years old; mean, 58 years old) fecal incontinence developed 15- 30 years after childbirth. In the latter group of patients, terminal motor latencies of the pudendal nerve were measured. Imaging was done on a 0.5-T Picker Asset unit and on a 1.0-T Picker HPQ unit. A saddle geometry endoanal receiver coil was used for all imaging. T1-weighted spin-echo (720-820/20 [range of TR/TE]), T2-weighted spin-echo (2500/80 [TR/TE]), fast spin-echo (4500/96 [TR/ effective TE]), and short inversion time inversion recovery (2500/80 [TR/TE]; inversion time, 107 msec) MR images were obtained in transverse, coronal oblique, and sagittal planes. Images were assessed for integrity of the sphincter components. A nonpaired separate-variance t test was used to compare thickness of individual muscle components between patients with delayed-onset fecal incontinence and asymptomatic age-matched volunteers. Degree of muscle atrophy was correlated with degree of delay in the terminal motor latency of the pudendal nerve. RESULTS: The high resolution obtained with an endoanal coil allowed differentiation of the various muscle components of the anal sphincter complex. The internal sphincter was seen as a ring of homogeneously high signal intensity with a low-signal-intensity rim that was rich in collagen and contained neurovascular bundles. The external anal sphincter, which had low signal intensity on T1- and T2-weighted images, was shown as three components: subcutaneous, superficial, and deep. In six patients who had fecal incontinence that began immediately after childbirth, endoanal MR imaging revealed the site and extent of a tear. All tears were confirmed at surgery. In the 16 patients who had fecal incontinence that began several years after childbirth, atrophy of the external sphincter was revealed in all cases in the superficial and deep components. The internal sphincter remained normal. However, we found that the degree of atrophy of individual components of the external sphincter did not correlate with the degree of delay in pudendal nerve conduction. CONCLUSION: MR imaging with an endoanal coil reveals the integrity and bulk of individual muscle components of the anal sphincter in multiparous women with fecal incontinence.

Adult↗
PubMed1988

Infants' face-recognition by primiparous and multiparous women.

We have compared the ability of 49 primiparous and 75 multiparous women to recognize photographs of their newborn infants. In line with previous research on infant cries, we found that multiparous women who had been with their infant 0.5 to 5.0 hr. were significantly more successful in recognizing their infants' photographs than primiparous women with comparable exposure to their newborns. For women who had not been with their infants more than 5 hr., parity was not related to recognition. We propose that the transient performance deficit of the primiparous women indicates a short-lived impairment of perceptual/cognitive skills associated with their more stressful childbearing experience.

Adult↗
PubMed1995

Effects of energy source in the diet on reproductive hormones and insulin during lactation and subsequent estrus in multiparous sows.

Two experiments were performed. The first experiment was done to study the effects of dietary energy source on plasma insulin concentration using five gilts in a Latin square design with two diets over two periods. The diets contained either 200 g/kg of cornstarch (Starch) or soybean oil (Fat) as energy sources. Results indicate that insulin response was greater in the Starch-fed than in the Fat-fed gilts. A second experiment was performed in which 18 multiparous sows were fed one of the two experimental diets from farrowing until slaughter at d 35 of subsequent pregnancy. All sows nursed nine pigs. Blood samples were taken from a permanent jugular vein catheter every 12 min during a 12-h period on d 109 +/- 1 of pregnancy, on d 7 +/- 1, 14 +/- 1, and 21 +/- 1 of lactation, and on the day of weaning ( d 22 +/- 1). From 48 h after weaning, blood samples were taken every 4 h until 24 h after ovulation. After that, blood samples were taken at 12-h intervals until d 10 after ovulation. Differences between diets in insulin response were not significant. In Starch-fed sows, LH pulsatility at d 7 of lactation was greater (P < .05), the preovulatory LH surge was greater ( P < .05), and progesterone production was greater (P < .05) from 108 h until 256 h after the LH surge than in the Fat-fed sows. Results indicate that feeding Starch-rich diets to multiparous sows compared with Fat-rich diets, on an isocaloric basis, increases LH pulsatility during early lactation, the preovulatory LH surge, and progesterone production after the LH surge.

Animals↗
PubMed1996

Reconstitution of body reserves in multiparous sows during pregnancy: effect of energy intake during pregnancy and mobilization during the previous lactation.

Multiparous Large White sows were used in two experiments to determine the effects of energy intake on the reconstitution of body reserves during pregnancy. In Exp. 1, 21 sows received one of three different energy levels during pregnancy: 7.4, 8.8, or 10.4 Mcal DE/d. In Exp. 2, two energy levels (7.9 and 9.2 Mcal DE/d) were fed to 36 sows that mobilized low or high amounts of body reserves during the previous lactation (6 or 12 pigs per litter, respectively). Nitrogen balances were conducted during five 7-d periods at 11, 32, 53, 82, and 104 d of gestation. All the experimental sows were slaughtered and dissected at the end of pregnancy; 24 control sows were similarly slaughtered at mating in order to estimate composition of BW gain, according to the comparative slaughter technique. In the two experiments, average nitrogen (N) retention increased linearly with energy supply from 9.9 to 14.5 g/d in Exp. 1 (P < .001) and from 10.2 to 12.5 g/d in Exp. 2 (P < .05). Nitrogen retention was not affected by the extent of mobilization of body reserves during the previous lactation in Exp. 2. In both experiments, carcass weight (P < .001), muscle weight (P < .01), and dissectable fat weight (P < .001, Exp. 1; P < .01, Exp. 2) increased with energy supply. We conclude that in high-producing modern multiparous sows, energy supply during gestation is a limiting factor for N retention and muscle weight gain and should be approximately 8,500 kcal DE/d to ensure adequate restoration of body reserves.

Animals↗
PubMed2000

Adaptations of glucose metabolism in multiparous sows: effects of pregnancy and feeding level.

This experiment was undertaken to determine whether pregnancy affects glucose metabolism and insulin sensitivity in sows fed at different levels. Four replicates of six multiparous Large White sows were involved. In each replicate, four sows were inseminated on the first postweaning estrus (pregnant group) and the two remaining were kept nonpregnant. Half of the sows of each group were fed 2.5 kg/d (low level) and the others 4 kg/d (high level) of the same standard pregnancy diet. Jugular catheters were implanted 2 to 3 d after estrus. Plasma concentrations of glucose, insulin, and FFA were determined before and during the 4 h following the morning meal at 10, 30, 59, 87, 93, 101, and 110 d of gestation and at equivalent periods for the nonpregnant sows. Intravenous glucose tolerance tests were performed at 33, 71, 85, 96, and 108 d by i.v. injection of 0.5 g glucose/kg BW. Compared with the glycemia before the meal, all the sows showed hyperglycemia 30 min after the initiation of the meal and hypoglycemia thereafter, with a minimum reached at approximately 75 min. Insulinemia increased from 20 min after food access, reached a maximum at 40 min, and returned to the basal level after 180 min. The higher feeding level increased plasma insulin and lowered plasma glucose levels. Glycemia and insulinemia profiles changed from 87 d onward in the pregnant sows. The peak of glucose induced by the meal was higher, and the subsequent period of hypoglycemia almost disappeared. The area under the insulin curve was unchanged, but insulin secretion was delayed. The glucose tolerance tests showed that between d 85 and 108 the half-life of injected glucose increased and insulin secretion was delayed in the pregnant sows. Compared to the following stages, plasma FFA were high before and after the meal at 10 d, which most likely was a residual effect from the previous gestation/lactation cycle. They were lower from 30 to 101 d in the pregnant and nonpregnant sows. At 110 d, fasting FFA were high again in the pregnant sows only, very likely in relation to the preparation for lactation. This experiment showed that insulin sensitivity decreases after 85 d of pregnancy in multiparous sows.

Adaptation, Physiological↗
PubMed1998

Thermal stability of bone collagen as an indicator of bone turnover in gonadectomized and multiparous rats.

Previous findings indicate that the thermal stability of bone collagen is related to age. In this study, collagen from rat bone with reported different turnover rates was investigated. Cortical and trabecular bone from femur were obtained from intact, ovariectomized, orchidectomized and multiparous breeder rats. Thermal stabilities of fibrillar collagen in decalcified bone matrix and molecular collagen obtained by pepsin treatment were measured as shrinkage (Ts) and 'melting' temperature (Tm), respectively. Both Ts and Tm of cortical collagen from intact female rats decreased in parallel with age as previously found in male rats indicating that Ts and Tm measurements are interchangeable techniques in characterizing the thermal stability of bone collagen. Tm of trabecular collagen from intact rats decreased with age, however, with a decay only one-third of that for cortical collagen. The different rates possibly reflect different ages of collagen due to remodeling activity present in trabecular and minimal in cortical bone. Compared with control rats the Tm of trabecular collagen from gonadectomized and multiparous rats with a reported increased trabecular turnover rate was elevated, whereas only minor variations in Tm of cortical collagen were found. In conclusion, the thermal stability of bone collagen decreases with the age of the collagen. Increased bone turnover implies elevated thermal stability of bone collagen. Thus, thermal stability of bone collagen appears to be an indicator of bone turnover.

Aging↗
PubMed2003

Responses of primiparous and multiparous Holstein cows to additional energy from fat or concentrate during summer.

Supplemental fat has been advocated for use during hot weather and often increases milk yield of cows past peak production when energy intake should not be limiting. Relative responses of primiparous and multiparous cows to supplemental fat or isocaloric addition of concentrates under hot weather conditions have not been determined. Nine multiparous and nine primiparous Holstein cows (154 and 167 d in milk, respectively) were used in a replicated 3 x 3 Latin square design with 28-d periods. Diets were 1) control (35% alfalfa silage, 25% corn silage, and 40% concentrate, dry matter [DM] basis); 2) control plus 3% fat (HF); and 3) high concentrate ([HC] 15% alfalfa silage, 25% corn silage, and 60% concentrate). Diets were isonitrogenous; diets HF and HC were isocaloric (1.60 Mcal of net energy for lactation [NE(L)] per kilogram DM) and higher energy than the control (1.52 Mcal/kg). No parity x diet interactions approached significance. DM intake (DMI) was greater when cows were fed HC than when they were fed HF (21.0, 20.1, and 21.3 kg/d for control, HF, and HC, respectively); intake of NE(L) tended to be increased only for HC. Milk yield was increased by higher-energy diets, but milk fat content was decreased. Milk total protein content was decreased by HF and increased by HC. Yield of solids-corrected milk (SCM) was not different among diets. Efficiency of milk production, expressed either as total milk solids yield per kilogram of DMI or as kilograms of SCM per megacalorie of NE(L) intake, was greater for HF than for HC. Plasma glucose was higher after feeding for cows fed HC; plasma nonesterified fatty acids were greater for HF. Respiration rate and rectal temperature were greater for HC than for HF. Regardless of parity, increased energy density from either fat or concentrate increased milk yield in midlactation cows, but diets caused energy to be partitioned differently among milk components and body storage. Supplemental rumen-active fat had modest advantages over additional starch-based concentrate during summer heat conditions.

Animals↗
PubMed2005

Periparturient responses of multiparous Holstein cows fed different dietary phosphorus concentrations prepartum.

Our objective was to compare the effects of different prepartum dietary phosphorus concentrations on periparturient metabolism and performance. Forty-two late pregnant multiparous Holstein cows were fed 0.21, 0.31, or 0.44% P (dry basis) for 4 wk before expected calving. After parturition, all cows were fed a common lactation diet (0.40% P). In the prepartum period, cows fed 0.21% P had lower blood serum P concentrations compared with cows fed 0.31 or 0.44% P. However, serum P concentrations of all cows were within the normal range (4 to 8 mg/dL) until the day of calving when average concentrations dropped below 4 mg/dL. From 3 to 14 d postpartum, serum P of cows fed 0.21% P was greater than that of cows fed 0.31 or 0.44% P. No cows presented with or were treated for clinical hypophosphatemia in the periparturient period. Total serum Ca was lower before calving through 2 d postpartum for cows fed 0.44% P compared with those fed 0.21 or 0.31%. Prepartum dietary P treatments did not alter blood osteocalcin, hydroxyproline, and deoxypyridinoline, indicators of bone metabolism, or concentrations of parathyroid hormone or 1,25-dihydroxyvitamin D3. Energy-corrected milk yield and milk composition (first 28 d of lactation) were not affected by prepartum dietary P concentrations. It is concluded that feeding 0.21% P (34 g of P/cow daily) prepartum is adequate for periparturient multiparous Holstein cows with high metabolic demands and genetic potential for milk production. No adverse effects on periparturient health, dry matter intake, or 28-d lactation performance resulted.

Animals↗
PubMed2001

Family planning in grand multiparous women in Diyarbakir, Turkey, 1998: the factors affecting contraceptive use and choice of method.

Family planning is an important service for preventing maternal deaths. A 3-year project on children and maternal health was conducted in suburban areas of the Diyarbakir province of Turkey. In this project, volunteer women told women resident in the area about family planning as well as other maternal and child health-related subjects. Within 3 years, all women were visited at least five times and changes in contraceptive use were recorded. A cross-sectional study was planned to understand the factors affecting contraceptive use in grand multiparous women. A total of 200 grand multiparous women were selected from visit cards and various characteristics of these women were evaluated. Odds ratios and 95% confidence intervals were calculated using logistic regression analyses. The use of contraceptives had increased from 33.5% to 59.5% by the end of the 3 years in the 200 women. The main factors affecting contraceptive use were misconceptions and concerns about health-related risks, having a child younger than 14 years working outside the home to contribute to the household income, religious opposition, a gap between the desired and actual number of sons, number of previous deaths of children and discussion with the husband about family planning.

Adult↗
PubMed2002

Elective induction of labor in multiparous women. Does it increase the risk of cesarean section?

OBJECTIVE: To determine whether the medical initiation of labor places the multiparous woman at increased risk of cesarean section. STUDY DESIGN: This study was a retrospective, case-control assessment of the risk of cesarean section in multiparas with no medical or obstetric complications and vertex presentations whose induction of labor at term was judged to be elective by chart analysis. Case women were matched for age, parity, gestational age and staff obstetrician with controls in spontaneous labor, and the rates of cesarean delivery were compared. RESULTS: Three hundred four case-control pairs were studied. No significant difference was observed in the rate of cesarean delivery between the two groups. The rate of cesarean section in the electively induced group was 3.6% versus 4.3% in the control group (P = .6670). Neither cervical state nor use of cervical ripening agents significantly affected the rate of cesarean delivery. CONCLUSION: As compared with spontaneous labor, the elective induction of labor in multiparous women without complications does not predispose to cesarean delivery.

Adult↗
PubMed1992

[Iron metabolism, hemopoiesis, prevention and treatment of iron deficiency anemia in multiparous women].

A total of 160 multiparous women with iron deficiency anemia (IDA) who have 4 and more children were under study. Hemoglobin parameters in patients with non-severe anemia (n = 64) fluctuated from 119 to 90 g/l, in patients with moderate severity (n = 60) from 89 to 70 g/l, in those with severe stage of anemia--69 g/l and lower. The latent anemia group consisted of women whose hemoglobin values were 120 g/l and higher, however, the figures characterizing serum iron, transferrin and ferritin content evidenced iron deficiency. Parameters of serum iron, transferrin and ferritin metabolism were studied in all the patients. Decreased levels of serum iron and ferritin and a compensatory increase of transferrin content were recorded. Manifest signs of acquired dyserythropoiesis and a significant increase of ineffective erythropoiesis (34.96 +/- 0.89%) were demonstrated in myelograms. It has been recommended that routine measures used for the treatment of IDA in multiparous women should be supplemented by anabolic agents and blood substitutes for protein parenteral nutrition.

Anemia, Hypochromic↗
PubMed1989

Grand multiparity--a nationwide survey.

Grand multiparity has been considered to be an obstetric hazard to both the mother and the fetus. In order to evaluate this statement we analyzed the information of a nationwide survey. The delivery records of all women (22,814) attending 30 obstetric wards in Israel between November 1983 and January 1984 were analyzed and the medical and obstetric complications associated with grand multiparity were investigated. Diabetes, hypertension, malpresentations, multiple births, large-for-gestational-age deliveries and perinatal deaths were found to be significantly more common in 1,542 multiparae who had seven or more deliveries. The association between parity and age partially accounted for this observation.

Adolescent↗