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PubMed1984

Multiple gestation: time interval between delivery of the first and second twins.

A clinical investigation was undertaken to challenge the commonly accepted view that the interval between the birth of the first and second twins should be preferably within 15 minutes and certainly no more than 30 minutes. During 1981 and 1982, 115 patients with live-born twins at 34 or more weeks' gestation underwent an attempted vaginal delivery at four regional perinatal centers. The interval between vaginal delivery of the first and second twins (mean, 21 minutes, range, one to 134 minutes) was 15 minutes or less in 70 (61%) cases and more than 15 minutes in 45 (39%) cases. Excluding conditions associated primarily with prematurity, all second twins delivered beyond 15 minutes did well despite the delay and had no signs of excess trauma or low five-minute Apgar scores. Maternal complications were also uncommon, although combined vaginal-abdominal delivery was more frequent if there was a delay of more than 15 minutes (eight of 45 versus two of 70, P less than .02). The authors conclude that if there is continuous fetal and uterine monitoring, a time restriction for the delivery interval between the first and second infants is not necessary.

Adult↗
PubMed1995

[Fetal risk factors in twin pregnancies. Critical analysis of 265 cases].

The authors report their critical analysis of perinatal mortality concerning 265 twin pregnancies collected between 1982 and 1993 in the Maternity Unit of the Yaoundé (Cameroon) Teaching Hospital Group. There were a total of 14,277 deliveries during this period. The twin pregnancy rate was 1.8 per cent. Delivery was spontaneous in 89.6 per cent of cases and by cesarean section in 10 per cent of cases. In 3 cases the second twin was delivered by section after spontaneous delivery of the first twin. Perinatal mortality evaluated at 6.9 per cent (37 cases) was analysed according to fetal risk factors such as gestational age, type of delivery, fetal presentation, birth weight, birth rank and the time interval between birth of the first and second twin. Perinatal mortality of premature twins with 25 fetal deaths accounted for approximately 2/3 of the fetal deaths in this series. Twenty-two cases of fetal deaths seen in the group of second twins accounted for more than half of all fetal mortality. The time interval between the two births was an important factor in the fetal prognosis of the second twin. There were 14 cases of death of the second twin for a time interval longer than 20 minutes as compared with 8 fetal deaths for an interval of 20 minutes or less. Breech presentation was associated with abnormally high fetal mortality (16 cases). Our conclusion is that improved perinatal mortality in twin pregnancies must be sought by preventing prematurity. Breech presentation is a factor of poor prognosis, in which it is important to widen indications for prophylactic cesarean section aimed at improving fetal prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Delivery, Obstetric↗
PubMed2006

A questionnaire-based study of gestation, parturition and neonatal mortality in pedigree breeding cats in the UK.

This study was based on a convenience-sampling questionnaire study of pedigree cat breeding in the UK. Data were collated for the births of 1,056 litters from 14 different pedigree breeds and 942 different households. Significant relationships between various outcomes and relevant predictors were assessed by multiple linear regression or logistic regression as appropriate. The overall mean gestation length of 65.1 days varied significantly between the breeds (P<0.0001), and larger litter sizes were associated with shorter gestation lengths (P=0.04). The mean litter size of 4.6 kittens also varied significantly according to breed (P<0.0001). The weight of kittens born alive (overall mean 93.5 g) increased with longer gestation lengths (P=0.0003), decreased with larger litter sizes (P<0.0001) and varied between the breeds (P<0.0001). A total of 8.0% of pregnancies resulted in a caesarean section, with a higher risk associated with smaller litter sizes (P=0.002). Although the frequency of caesarean sections varied from 0 to 18.5% between individual breeds, breed itself was not shown to have a significant independent effect on this likelihood. A mean of 7.2% of all the kittens were stillborn, which varied according to breed (P=0.0003), and the risk of a stillborn kitten increased with litter size (P=0.0001), and with the presence of congenital defects in the litter (P=0.0002). The mean kitten mortality between birth and 8 weeks of age was 9.1%, and the majority of these occurred in the first week of life. Parturition intervals varied widely. The duration of first stage of labour was less than 2h in 82.9% of cats. The interval between the birth of the first and last kitten was less than 6h in 85.7%, but more than 48 h in three cats. A maximum of 48 h was recorded between the births of individual kittens in unassisted deliveries.

Animals↗
PubMed2003

Subfertility reflects accelerated ovarian ageing.

BACKGROUND: The aim of the study was to explore the extent to which accelerated ovarian ageing may lead to subfertility early in reproductive life and eventually cause early menopause. METHODS: The population studied (n = 2393) never used oral contraceptives, hormone replacement therapy or an intrauterine device. Logistic regression analyses were performed using age at menopause as proxy for accelerated ovarian ageing. Measures of ovarian ageing and subfertility were menstrual cycle irregularity, ever consulted a physician for fertility problems, nulliparity, uniparity, miscarriage(s) and time interval >5 years between birth of first and second child. RESULTS: For every 5 years later menopause, the probability of reporting menstrual cycle irregularity was reduced by 26% (OR = 0.74, 95% CI: 0.63-0.86); the probability of ever consulting a physician for fertility problems was reduced by 18% (OR = 0.82, 95% CI: 0.71-0.95); the probability of staying nulliparous was reduced by 22% (OR = 0.78, 95% CI: 0.64-0.96); the probability of being uniparous was reduced by 22% (OR = 0.78, 95% CI: 0.66-0.91); the probability of having a miscarriage was reduced by 11% (OR = 0.89, 95% CI: 0.79-1.01); the probability of a large time interval between birth of first two children was reduced by 27% (OR = 0.73, 95% CI: 0.61-0.89). CONCLUSIONS: Fertility problems are frequently followed by early menopause. The findings support the view that both are an expression of accelerated ovarian ageing.

Abortion, Spontaneous↗
PubMed1989

To what extent does breastfeeding explain birth-interval effects on early childhood mortality?

This article shows that in Nepal breastfeeding almost completely explains the effects of following birth interval on childhood mortality during the first 18 months of age and partially explains the effect of following birth interval on childhood mortality between 18 and 60 months of age. Breastfeeding does not explain the effect of preceding birth interval on childhood mortality. The analysis is based on application of hazard models to data from the 1976 Nepal Fertility Survey.

Birth Intervals↗
PubMed1990

Age at first marriage and fertility in rural Anhui, China.

This paper examines the changing nuptiality pattern of rural China, particularly rural Anhui in relation to the planned social changes since 1949 and their effect on fertility. The data are from the 1/1000 Fertility Survey of China, conducted by the Family Planning Commission in 1982. Before the family planning programme was introduced to rural Anhui (1972), the changing nuptiality pattern was indirectly affected by the planned social changes; after 1972, the substantial increase in age at first marriage was mainly due to the family planning programme. More recently, the centrally controlled social structure is loosening, due to the economic reform and the nuptiality pattern seems to join the 1972 trend, suggesting that the dramatic change of nuptiality pattern during the early 1970s to early 1980s was a temporary one. But its effect on fertility is clear, and the shortening interval between marriage and first birth may bring difficulties for future population control in rural China.

Adult↗
PubMed2004

Parturition in gilts: duration of farrowing, birth intervals and placenta expulsion in relation to maternal, piglet and placental traits.

Large White x Meishan F2 crossbred gilts (n = 57) were observed continuously during farrowing while the placentae of their offspring were labeled in order to examine the duration of farrowing and placenta expulsion in relation to maternal-, piglet- and placental traits and the duration of birth interval in relation to birth weight, birth order and placental traits. Independently from each other, litter size, gestation length and offspring directed aggression significantly (P 0.05) affected duration of farrowing. An increase in litter size was associated with an increase of duration of farrowing and an increase in gestation length was associated with a decrease of duration of farrowing. Aggressive gilts took longer to farrow, compared to non-aggressive ones. After taking into account litter size, gestation length and offspring directed aggression, placental thickness (i.e., placental weight corrected for placental surface area) was significantly (P < 0.05) related to duration of farrowing, i.e., litters with on average thicker placentae took longer to farrow. The latter effect is the result of the fact that individual placental thickness significantly (P < 0.01) affected individual birth interval, independent of birth weight. The piglet has to break its own membranes to be able to start its journey through the uterus towards the birth channel. Apparently, a thicker placenta offers more resistance and thus prolongs the process of birth. Independent of placental thickness, birth interval significantly (P < 0.01) decreased with an increase in birth order (first born to last born). The high variation of birth intervals for the last born piglets, caused a slight increase in average birth interval for the latter piglets. Litters with on average more areolae per placenta took significantly (P < 0.001) less time to be born than litters with on average less areolae per placenta (independent of total number of piglets born and other placental traits), while birth intervals within litters were not affected by this trait. Thus, these results are probably due to a gilt trait rather than a piglet trait. Since the number of areolae represent the number of uterine glands present, the gilt trait might be uterine development. Duration of placenta expulsion significantly (P < 0.01) increased with an increase of duration of farrowing. Furthermore, the first placenta was expelled significantly (P < 0.01) earlier relative to last piglet when duration of farrowing was protracted, while there was no relation of the time interval between first placenta and last piglet and the duration of placenta expulsion. In conclusion, the most important finding of this study is that placental thickness rather than birth weight appears to play an important role in the duration of birth intervals and as a result, of duration of parturition in gilts.

Aggression↗
PubMed1986

The place of child-spacing as a factor in infant mortality: a recursive model.

This study investigates the role of a preceding birth interval in infant mortality by considering a causal ordering of seven variables. Data are from the 1974 World Fertility Survey for Korea and cover the survival of 6,161 index children. A two-stage logit model was used. The analysis suggests that infant mortality is directly influenced by the preceding birth interval which, in turn, is influenced by five other explanatory variables: maternal age, birth order, immediately preceding infant's death, education of mother, and place of residence. Maternal age and prior infant death also exert direct effects on mortality. In terms of relative risk, prior infant death has the strongest effect of all the explanatory variables. A longer birth interval increases the odds of an infant's survival by 25 per cent, whereas the death of a preceding child decreases the odds by 45 per cent. However, infant deaths in Korea occur infrequently in comparison with short birth intervals. Thus, the two factors present comparable attributable risks in unadjusted measurements. The first-stage causal structure affecting a birth interval is more complicated than the second-stage structure affecting infant mortality.

Adult↗
PubMed2005

The impact of interpregnancy interval and previous preterm birth on the subsequent risk of preterm birth.

OBJECTIVE: To examine the impact of the interpregnancy interval and a previous preterm birth on the subsequent risk of a preterm birth. METHODS: A retrospective analysis was conducted on a group of 4072 women who had at least two consecutive births, excluding multiple gestation, fetal anomalies, cervical incompetence, and stillbirth. Multivariate logistic regression was used to investigate the association between interpregnancy interval, preterm birth of the first child in the pair (index pregnancy), and the risk of a preterm birth of the second child in the pair (outcome pregnancy). RESULTS: Women with interpregnancy intervals of less than 12 months (odds ratio [OR] 1.3; 95% confidence interval [CI] 1.0-1.7) were at increased risks of preterm birth with the outcome pregnancy. Furthermore, there was an increased risk for a subsequent preterm birth in women who had a preterm birth in the index pregnancy (OR 4.2; 95% CI 3.0-6.0). The risk decreased as the interpregnancy interval increased, with a relatively low risk at 18 to 48 months; subsequently, it increased sharply. In contrast, women who had delivered their previous infants at term carried an increased risk of preterm birth with the outcome pregnancy only if the interval was less than 6 months. CONCLUSION: A difference was found in the impact of the interpregnancy interval on the subsequent risk of preterm birth between women with a prior preterm birth and those who previously delivered an infant at term.

Adult↗
PubMed1975

A method for the estimation of fecundability.

A new method for the estimation of the mean and variance of fecundability is described. The data input required for this procedure is the distribution of the interval from marriage to first birth, or from the resumption of the conception risk after contraction to the subsequent birth. The estimates of the mean and variance of fecundability are obtained by fitting a model to the observed interval distribution. To test the method, it is applied to data from five historical populations. The fecundability means in these populations ranged from 0.18 to 0.31 while the co-efficients of variation all had values near 0.56. A short method for the estimation of the mean of fecundability based on the same model, but not requiring a computer, is also presented.

Abortion, Spontaneous↗
PubMed1993

The association of height, weight, menstrual and reproductive events with breast cancer: results from two prospective studies on the island of Guernsey (United Kingdom).

The association with breast cancer of menstrual and reproductive events, family history of breast cancer, and body size have been studied on two cohorts of 6,706 volunteers on the island of Guernsey (United Kingdom), 168 of whom had breast cancer detected during follow-up. The median follow-up time of the non-cases was 21 years in the first study and 10 years in the second. A time-dependent Cox regression model was fitted to the data with age as the time-dependent variable in order to represent the effect of changing menopausal status. Other variables examined in the model were age at menarche, parity, age at first birth, family history of breast cancer, height, weight (both directly measured), relative weight (weight [kg]/height[m]), and Quetelet's body mass index (weight[kg]/height[m]2). Interactions between age and all other covariates also were examined. Family history was found to be the most important risk factor for women aged less than 51 years (relative risk [RR] = 3.5, 95 percent confidence interval [CI] = 2.0-6.0), and intervals between menarche and first birth longer than 14 years were found to increase significantly the risk of breast cancer in women older than 61 years (RR = 2.4, CI = 1.3-4.4). Height was the only indicator of body size which was associated significantly with risk of breast cancer, the estimated regression coefficient indicating an increase in risk of about 70 percent for women on the 90th centile of height relative to those on the 10th centile. A survey of the literature showed that the association between risk of breast cancer and height was found in those studies which used direct measurements of height but not in others which used self-reported values.

Age Factors↗
PubMed2006

The hysterectomized woman. Is she special? The women's health in the Lund area (WHILA) study.

OBJECTIVE: To delineate the health profile of hysterectomized women and to assess whether women who have undergone hysterectomy have a different health profile even before surgery. MATERIAL AND METHODS: The WHILA project covers all women (n = 10,766) aged 50-60, living in the Lund area and are based on questionnaires and personal interviews tied to laboratory examinations. RESULTS: 6917 women (64.2%) had complete questionnaires and laboratory tests, 800 were hysterectomized (11.6%). Logistic regression analysis revealed that hysterectomized women had more "dizziness" 1.40 (1.19-1.66), "nervous problems" 1.29 (1.07-1.56), "backache" 1.37 (1.16-1.62), "joint problems" 1.29 (1.09-1.52), "eye problem" 1.20 (1.02-1.42) and "headache" 1.17 (1.00-1.37). For both somatic (5.22 versus 4.49 mean value, p < 0.001) and psychological (4.19 versus 3.86 mean value, p = 0.002) symptoms, the number was higher in hysterectomized women. Logistic regression analysis revealed that among hysterectomized women university education was less common odds ratios 0.73 (95% confidence interval 0.58-0.91) as well as working full time 0.76 (0.62-0.93). A higher body weight at the age 25, 1.01 (1.001-1.02) as well as a weight gain of more than 5 kg during the last 5 years 1.27 (1.07-1.50), elevation of serum triglycerides 1.29 (1.16-1.44), high-density (HDL) 1.44 (1.14-1.80) and low-density lipoprotein (LDL) cholesterol 1.11 (1.02-1.21) as well as the bone density 1.08 (1.00-1.17). Hysterectomized women had a lower age at giving first birth (p < 0.001), shorter interval between menstrual periods (p < or = 0.001) and less frequent amenorrhic episodes (p < 0.05). The hysterectomized women used IUD to a lesser extent (p < 0.05) but used hormone therapy (HT) (p < 0.001) and utilized health care services (p < 0.001) more often. CONCLUSIONS: Long after surgery, several somatic and psychological symptoms were still more common in hysterectomized women. A low frequency of amenorrhic episodes and lower age at giving first birth, concomitant with a higher body weight already at age 25 may imply that women who end up hysterectomized have a specific health profile long before as well as long after surgery.

Age Factors↗
PubMed1993

Delayed birth intervals of immature fraternal triplets in preterm labor. A case report.

The preterm birth of immature triplets before 28 weeks is associated with excess morbidity and mortality risks attributable to extreme immaturity. We report a case of fraternal triplets in preterm labor in which the second and third triplet births were delayed 11 days after the first birth, at 26 4/7 weeks' gestation. The later-born sibs were heavier at birth and throughout their neonatal course in the hospital and suffered less severe complications as compared to the first-born triplet. Delayed birth intervals of triplets in preterm labor should be considered to improve perinatal salvage of immature triplets, although a successful outcome is rare and unexpected.

Adult↗
PubMed1999

Age at marriage and intrafamily planning in young families.

INTRODUCTION: The sociological inquiry on current problems of intrafamily planning carried out in 1995 provided opportunities for finding the effect of a number of social and demographic factors on the formation of family. OBJECTIVE: The present study has investigated the influence of the age of woman at marriage on the main indicators characterizing the reproductive behavior. MATERIAL AND METHODS: Direct individual inquiry was performed and 500 young families from the town of Plovdiv were approached. Data were analyzed by percentage distribution methods and non-parametric tests. RESULTS AND DISCUSSION: We should note here the high percentage of spouses who had not planned the number of children in their future family--33.1% of women and 34.3% of men. Paradoxically, the percentage of women that had not planned the number of children in their families increases with age. The intended number of children does not depend on the age of women at marriage. The women aged below 19 have indicated the highest number of children. The "ideal number of children" indicator has the highest value in women aged below 19 (2.25 children), but there is no statistically significant difference in the ideal number of children between the different age groups. The opinion about a "large family" is studied in spouses and relatives of the young family. With the increase of age, the number of children in the "large family" decreases in all three groups (P < 0.001). There is no difference in length of the protogenetic interval between different age groups. Intergenetic interval between the first and second birth is about three years in all three age groups. The largest interval between the second and third birth is registered in women aged above 25. About half of the women have admitted that they do not wish to have a third child. The age at last delivery is highly correlated with age at marriage (P < 0.05); the correlation is strongest in women above 25 years of age.

Adolescent↗
PubMedDate not supplied

The effects of the sequencing of marriage and first birth during adolescence.

Whether or not they marry, black adolescent mothers are more likely than whites to attend school following the birth of their first child. Marrying to legitimate a birth reduces the likelihood that a teenager will return to school after childbearing; this impact of marriage is much stronger among black than among white teenagers. The timing of marriage appears to affect school enrollment among white teenagers through its impact on living arrangements. However, the negative impact of marriage on educational achievement does not seem to be a consequence of earlier differences in educational expectations among the teenagers. Teenage mothers appear less likely to separate from their husbands in later years if they marry before the birth than if they marry afterward. Delaying marriage until after the birth has a long-term effect on the probability of separation among white teenage mothers, but has only a short-term impact among blacks. Among teenagers who marry before giving birth, there is little difference in the likelihood of separation between those who marry before becoming pregnant and those who do so afterward. In addition, the effect of the sequence of marriage and first birth among white teenage mothers may have declined in recent years. Adolescent mothers who do not marry before their first birth experience a longer interval between that birth and their second than do those who marry either before or during the pregnancy. These differences are primarily the result of short-term variations in the amount of time they spend married; that is, women who are unmarried when they give birth are less likely to have a second birth soon afterward.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

An initial assessment of the risk approach to antenatal management in Malaysia.

This study was the first assessment of a nationwide risk approach system to antenatal management introduced to Malaysia in 1989. Three rapid, record-based surveys on three different study groups were conducted to determine risk factor prevalence, accuracy of risk assignment, action after risk assignment and the relationship of risk level and place of delivery. The most frequent risk factors were short birth interval, high parity and first pregnancy. Accuracy of risk assignment was highest at the lowest levels of risk and poorest at the highest levels. Women at the lowest levels of risk were more likely to be seen by a doctor than women at highest risk. These was a trend to deliver in hospital, rather than at home, as level of risk increased; but many women at high risk still delivered at home. Recommendations are made on modifications to the system prior to future evaluation.

Adult↗
PubMed2003

Women empowerment and marital fertility in Oman.

International studies have the inverse relationship of women education and empowerment on fertility. Our aim is to study the association of women education and empowerment with some of fertility indicators or determinants namely; total number of children ever-born, age of women at her first birth and the last closed birth interval length in a community based survey (National Health Survey, 2000) A cross-sectional survey of the health status of Omani community was designed. Face to face interview to 2037 ever married women including demographic data, fertility patterns, family planning, two women empowerment indices (decision making and freedom of movement), and other reproductive health modules. About 31% of the sample was considered highly empowered in decision- making and the mean number of decisions taken in the household was 4.46 for the overall sample. For freedom of movement, 29% of the sample was highly empowered with a mean number of 3.88 for the overall sample. The mean values of both indices varied significantly according to age, residence, level of education and work status. Higher freedom of movement score women was more likely to have less number of children in the first 20 years of marriage. Women of 'higher score of decision making index were more likely to have longer closed birth interval. Those scored low in the decision making index were more likely to get a child at an earlier age. In developing countries where fertility limitation depend on "modern" methods, women's education and autonomy are considered as strong tools to make changes in demographic transition.

Adolescent↗