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At least 1,423 records · Page 79Linked to original sources
PubMed1995

Psychosocial factors and pregnancy outcome: a review with emphasis on methodological issues.

This review focuses on the research concerning the relation between psychosocial factors and pregnancy outcome. The following four outcome measures are dealt with: (1) birth weight, (2) preeclampsia, (3) preterm labour, and (4) intrapartum complications. The most consistent finding concerns the association between maternal exposure to taxing situations and preterm delivery. Three possible pathways are hypothesized: (1) an indirect influence via unhealthy coping and life style behaviour, (2) a direct influence via stress-dependent hormones, and (3) an additional direct influence via psycho-immunological factors. Intervention studies aimed at improving pregnancy outcome show fairly mixed results. It is recommended that studies on the relationship between psychosocial factors and pregnancy outcome should employ a prospective design with due attention to chronic stressors, should include appropriate biochemical assessments, and multivariate techniques are applied.

Bias↗
PubMed2006

17alpha-hydroxyprogesterone caproate for the prevention of preterm delivery: A cost-effectiveness analysis.

OBJECTIVE: To evaluate whether the use of 17alpha-hydroxyprogesterone caproate for the prevention of recurrent preterm deliveries is cost-effective. METHODS: Using decision-analysis modeling, we compared the cost-effectiveness of using 17alpha-hydroxyprogesterone caproate in four subgroups: 1) Prior preterm deliveries less than 32 weeks; 2) prior preterm deliveries 32-37 weeks; 3) prior term delivery; and 4) no prior delivery. Each subgroup was compared with a "no treatment" group. Costs included those for 17alpha-hydroxyprogesterone caproate, hospital admissions, and complications from preterm deliveries. The main outcome measures include cost per quality-adjusted life-year gained and the number of preterm deliveries prevented. Secondary outcomes include neonatal complications prevented. One-way and multiway sensitivity analyses were performed. RESULTS: The use of 17alpha-hydroxyprogesterone caproate for the prevention of preterm deliveries result in cost-savings in women with prior preterm deliveries less than 32 weeks and 32-37 weeks. The sensitivity analyses revealed the model to be robust over a wide range of values for evaluated variables. CONCLUSION: Within our baseline assumptions, 17alpha-hydroxyprogesterone caproate was associated with cost-savings when used for the prevention of preterm deliveries in women with prior preterm deliveries.

17 alpha-Hydroxyprogesterone Caproate↗
PubMed1982

The relationship of blood lead levels to obstetric outcome.

Lead represents a significant environmental hazard to pregnant women and their offspring. Exposure to high environmental levels of lead has been associated with spontaneous abortion, premature rupture of fetal membranes (PROM), and preterm delivery. The relationship between lower exposures and obstetric complications is unknown. The concentration of lead in the blood was measured in 635 specimens of umbilical cord blood collected at delivery. No relationship was found between concentrations of lead in cord blood and the incidence of PROM, preterm delivery, preeclampsia, or meconium staining. Maternal and infant capillary blood was collected 24 hours post partum from 154 of these deliveries. The concentrations of lead in the blood did not vary significantly among cord, infant, and maternal samples, and the three measurements were highly correlated. Levels of zinc protoporphyrin (ZnP) were increased in cord blood as compared with mothers' blood, but no concentration-response relationships between the ratio of cord ZnP to maternal ZnP and lead were found.

Adult↗
PubMed2005

Long-term visual pathology in children with significant perinatal complications.

Eye research in infants who experience significant perinatal complications has been restricted to evaluation of structural ocular disease and spatial vision, and results show that these aspects of vision are at increased risk for abnormal or delayed development. To expand upon previous work, a battery of 17 vision tests was employed to assess, comprehensively, long-term outcome of functional vision. Seventy-six children (38 males, 38 females), between the corrected ages of 2 years 11 months and 10 years 2 months (mean 6y 6mo) with various significant complications (e.g. very preterm birth, bronchopulmonary dysplasia, intraventricular hemorrhage) were compared to normally developing, age-matched control children (n = 61; mean age 7y 1mo) on measures of visual acuity, contrast sensitivity, stereoacuity, peripheral vision, color vision, astigmatism, and binocular alignment. Results showed that at-risk children had more test results that fell within the suspect or abnormal range. At-risk children also had a slightly higher incidence of ocular disorders (e.g. strabismus) and refractive error. These data imply that children who experienced significant perinatal risk factors are at risk for long-term deficits of functional vision. However, most of these deficits appear to be relatively mild.

Bronchopulmonary Dysplasia↗
PubMed1993

A twenty-year retrospective analysis of the efficacy of epidural analgesia-anesthesia when administered and/or managed by obstetricians.

OBJECTIVE: The purpose of this study was to retrospectively determine the safety and efficacy of epidural anesthesia when administered by obstetricians in a community hospital. STUDY DESIGN: Data containing 14,598 epidural procedures from 31,818 births were obtained from delivery room logs over a period of 20 years, from 1972 through 1991. Data were displayed graphically to view trends over time. Odds ratios were calculated to determine the associations of epidural anesthesia with oxytocin stimulation, episiotomy, assisted vaginal delivery (forceps or vacuum extraction), and cesarean section. Particular scrutiny was given to any listed complication during labor or delivery. RESULTS: Over the 20-year period epidural anesthesia was administered without serious complication by various obstetricians with different training. Technique improved as procedures became standardized, resulting in an increase in the number of epidural procedures over the 20-year period. Incidence was also increased among women requiring oxytocin augmentation, episiotomies, and assisted vaginal deliveries. Of the total number performed, < 5% of patients required additional anesthesia. CONCLUSION: Over a 20-year period epidural analgesia or anesthesia has been an effective and safe procedure when performed and supervised by obstetricians-gynecologists in a community hospital.

Analgesia, Epidural↗
PubMed1979

[On the incidence of knots in the umbilical cord (author's transl)].

The mechanisms of the development of knots in the umbilical cord are described. The different types of knots are enumerated. The causative factors for the development of a knot in the umbilical cord are discussed. This paper is based on a statistical evaluation of the deliveries of the Maternity Hospital of the University of Bonn from 1967-1970. These data have been adopted from the Author's M.D. Thesis of 1972. At the end of the paper the comparative anatomy of the umbilical cord complications is discussed.

Female↗
PubMed1975

The quality of perinatal care received by patients in the Greater Harare area during 1973.

The perinatal deaths which occurred during 1973 in the Harare perinatal service were analysed in relation to their obstetric associations. Seventy-one per cent of all the deaths were associated with just five obstetric complications, namely asphyxia in laubour, preterm delivery, minor antepartum haemorrhage, unexplained intra-uterine death and disproportion. It is suggested that asphyxial deaths occurring labour will only be eliminated when continous cardiotocographic monitoring becomes standard practice for all patients. Until then, selected cardiotocography will remain as the main diagnostic aid. Its value will be improved by reviewing the principles of selection. The potential exists to eliminate preterm delivery by the use of beta-adrenergic stimulant drugs. It is suggested that the rational application of this potential would reduce perinatal mortality from preterm delivery. The unexplained intra-uterine deaths and those associated with a minor antepartum haemorrhage presented major problems of understanding and therefore management. These are discussed. Deaths associated with disproportion occurred in 0,10% of booked patients and 3,22% of unbooked patients. The management of the booked patient is satisfactory, and improvement in perinatal mortality will only be achieved by decreasing the number of unbooked patients.

Asphyxia Neonatorum↗
PubMed1989

Is elective cerclage justified in the management of triplet and quadruplet pregnancy?

The main complication in multiple gestation with more than two fetuses is prematurity, with its concomitant increase in perinatal mortality and morbidity. Clearcut indications as to management of these pregnancies are lacking, and the efficiency of elective cerclage is controversial. Twelve triplets and three quadruplets out of 27 multiple pregnancies were electively sutured and compared to 10 triplets and two quadruplets without this procedure. Otherwise, both groups were managed uniformly regarding bed-rest, beta-mimetic drugs and dexamethasone for the enhancement of fetal lung maturity. Mean duration of pregnancy in patients with cerclage was 35 weeks, significantly longer than those who did not undergo this procedure (30.7 weeks) (p < 0.01). Furthermore, in the former group, the mean neonatal weight was significantly higher (p < 0.01), mean Apgar scores were better, significantly lower rates of respiratory distress syndrome occurred (p < 0.05), perinatal mortality rate was significantly reduced (p < 0.01) and the mean hospitalization period was shorter (p < 0.025). It seems that elective cervical suture is a definite contribution to the successful management of multiple pregnancies with more than two fetuses.

Apgar Score↗
PubMed1991

Pregnancy outcome in an active-duty population.

The number of women in the military has grown since the initiation of the all-volunteer force. Pregnancy is no longer a justification for discharge from active service. Previously published reports have shown that active military service is associated with poor pregnancy outcomes. We compared a group of active-duty pregnant women (N = 331) matched for age and gravidity with a control group of dependent wives of active-duty personnel (N = 1218). Study variables examined were the incidences of cesarean and operative vaginal delivery, Apgar scores of less than 7 at 5 minutes, preterm complications (preterm labor and premature rupture of membranes) requiring transfer to a tertiary care center, pregnancy-induced hypertensive syndromes, intrauterine growth retardation (IUGR) (infant weight less than 2500 g), and pregnancy-related complications. In the active-duty group, the rates of primary cesarean (P less than .001), transfer for preterm complications (P less than .0001), pregnancy-induced hypertensive syndromes (P less than .01), and IUGR (P less than .05) were greater than in the control group. Active-duty servicewomen, despite defined limitations of work and ready access to health care, continue to represent a high-risk population.

Adult↗
PubMed1991

The effects of social support on women's health during pregnancy, labor and delivery, and the postpartum period.

This review of the literature on social support and its relationship to maternal health indicates that emotional, tangible, and informational support are positively related to mothers' mental and physical health around the time of childbirth. The importance of various types of support changes with the changing needs of women as they move from pregnancy to labor and delivery, and then to the postpartum period. During pregnancy, emotional and tangible support provided by the spouse and others is related to the expectant mother's mental well-being. In addition, informational support in the form of prenatal classes is related to decreased maternal physical complications during labor and delivery, and to improved physical and mental health postpartum. Mothers who have the support of a companion during labor and delivery experience fewer childbirth complications and less postpartum depression. Mothers' postpartum mental health is related to both the emotional support and practical help (eg, housework and child care activities) provided by the husband and others. Health care providers are in a unique position to educate prospective parents about the importance of social support around the time of childbirth and may play a critical role in mobilizing support systems for new mothers.

Delivery, Obstetric↗