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PubMed1986

Short-term associations between disease and milk yield of dairy cows.

Short-term associations between disease and milk yield were studied in 1594 lactations occurring between 1977 and 1982 in 732 Friesian, Ayrshire and Holstein crossbred cows. Statistically significant differences in milk yield between one week before and one week after clinical diagnosis were observed for ketosis (5.1 kg/d), hypomagnesaemia (4.1 kg/d), mastitis occurring after peak yield (2.1 kg/d) and lameness (1.1 kg/d). Milk yield declined for as much as 2-4 weeks before diagnosis of disease, and total losses in milk yield associated with ketosis or hypomagnesaemia were estimated to be 60-70 kg. No significant differences were found for endometritis or for mastitis when it occurred before peak yield. Milk yield was suppressed for about 4 weeks after calvings with retained placenta, but there were no corresponding effects of dystocia or hypocalcaemia on milk yield. It is suggested that if automatic daily milk recording is available it may be possible to detect deviations from normal, and hence detect subclinical disease 2 or more weeks before its clinical appearance.

Animals↗

PubMed1998

Maternal health and pre- and perinatal characteristics in the etiology of testicular cancer: a prospective population- and register-based study on Norwegian males born between 1967 and 1995.

OBJECTIVES: The aim of the present prospective study was to identify possible risk factors of testicular cancer (TC) in relation to gestation and birth. METHODS: Based on data from compulsory birth and cancer registration in Norway, odds ratios (ORs) of TC were estimated. RESULTS: Among 868068 males born between 1967 and 1995, 268 cases of germ cancer had developed by June 1996, 32 TCs before 5 years of age and 236 TCs thereafter, 48 cases being seminomas and 220 non-seminomas. There was a tendency of an inverse association between parity and TC. A previous finding from Sweden linking neonatal jaundice to risk of non-seminomas was confirmed (adjusted OR = 2.1, 95 percent confidence interval [CI] = 1.3-6.9). Significant associations were also seen for seminomas and TC diagnosed after 5 years of age. Maternal disease diagnosed before pregnancy increased the risk of TC significantly, particularly in the age group 0-4 years: Adjusted OR = 3.0, CI = 1.4-6.3. Retained placenta was significantly associated with both seminomas and non-seminomas and with TC diagnosed after 5 years of age. CONCLUSIONS: The findings of this study support the existing hypothesis that pre- and perinatal risk factors are of significance for development of TC in children and in young adults, and for seminomas and non-seminomas. The hypothesis that estrogens are involved in TC development was, among other factors, supported by the association of parity to TC. Additionally, on the basis of findings in maternal diseases and complications to pregnancy, we suggest that immune reactions during foetal life may be of significance for development of TC.

Adolescent↗

PubMed2003

The influences of dietary intakes and supplementation with selenium and vitamin E on reproduction diseases and reproductive efficiency in cattle and sheep.

Retained placenta, endometritis, cystic ovaries and low conception rates are often considered as interconnected conditions in cattle. Wide ranges in amounts of selenium and vitamin E supplements have been advised in late-pregnancy diets and, frequently, they can be synergistically beneficial. Animals at grass or with other green foods should be of adequate vitamin E status, but dietary selenium deficiencies are both more frequent and severe. Selenium status is important for super-ovulation in cattle and multiple births in ewes because of its importance in sperm transport and establishment of ova. However, the potential toxicity of selenium-enriched feed supplements restricts their use on a free-access basis. Giving sodium selenite or selenate by injection provides only a short-term response in the plasma. Barium selenate given in oil by injection provides a more durable response but has potential tissue residue problems. Compressed metallic selenium powder with iron powder in high-density reticulo-ruminal pellets gives sustained release, but uncertainties regarding possible surface coating and the variable effects of selenium particle size may require additional grinders to ensure prolonged release. Neither reticulo-ruminal pellets of such composition nor barium selenate by injection may be used worldwide because only sodium selenite and selenate have general regulatory approval. A sustained-release multi-trace element/vitamin rumen bolus system effective for several months has increased lambing percentages in ewes, and increased herd conception rates and reduced the spread of calving for herds of beef cattle.

Animals↗

PubMed1998

Suxamethonium and mivacurium sensitivity from pregnancy-induced plasma cholinesterase deficiency.

A fit 36-year-old parturient received a general anaesthetic for manual removal of a retained placenta. She underwent rapid sequence induction of anaesthesia with suxamethonium, shortly followed by 10 mg of mivacurium. One hour later she had failed to establish adequate ventilation despite administration of drugs to reverse neuromuscular blockade. A provisional diagnosis of suxamethonium-related apnoea was made and her lungs were ventilated overnight on the Intensive Care Unit. Plasma cholinesterase levels at the time were reduced to one-third of normal, with normal dibucaine and fluoride numbers. One month later her levels were back within the reference range.

Adult↗

PubMed1998

Associations of the bovine major histocompatibility complex DRB3 (BoLA-DRB3) alleles with occurrence of disease and milk somatic cell score in Canadian dairy cattle.

Potential associations were investigated between bovine leucocyte antigen (BoLA) alleles and occurrence of disease. Cows (Holstein n = 835; Jersey n = 66) were examined for polymorphisms of the second exon of the BoLA-DRB3 gene, using the polymerase chain reaction (PCR), followed by digestion of the amplified fragments with three restriction endonucleases. Disease occurrences were recorded for each cow throughout one lactation. Milk somatic cell count data were retrieved through the Dairy Herd Improvement records and converted to somatic cell score (SCS). There were no effects of BoLA alleles on SCS in Jersey cows, but BoLA-DRB3.2*16 was significantly associated (P < or = 0.05) with lower SCS in Holsteins. Since the number of Jerseys was relatively small and prevalence of diseases in this population was low, health records of Jerseys were not analyzed further. BoLA associations with occurrence of disease in Holsteins were investigated using a log-linear model. There was a significant (P < or = 0.05) association between BoLA-DRB3.2*23 and occurrence of severe mastitis, from which coliforms were the most commonly isolated bacteria. The BoLA allele *3 was associated with a lower risk of retained placenta (P < or = 0.05) and alleles *16 (P < or = 0.05) and *22 (P < or = 0.05) with a lower risk of cystic ovarian disease. Although more studies are required to confirm the present findings, it can be concluded that BoLA alleles may have potential usefulness as genetic markers of higher or lower risk of disease occurrence in cows.

Alleles↗

PubMed2002

Knowledge, attitudes and practices of trained traditional birth attendants in the Gambia in the prevention, recognition and management of postpartum haemorrhage.

OBJECTIVES: to assess the knowledge, attitudes, practices and the potential role of trained Gambian traditional birth attendants (TBAs) in the prevention, recognition and management of postpartum haemorrhage (PPH). DESIGN: a qualitative, reflective approach using semi-structured interviews followed by group discussions. SETTING: poorly-resourced rural villages in The Gambia, West Africa. PARTICIPANTS: 22 trained TBAs and their supervisors from 12 villages. FINDINGS: the TBAs recognised complications such as retained placenta and excessive blood loss and were well aware of the need to refer these women to a health facility quickly. Delay in referral was often due to late call-out of the TBA or lack of transport. Although the TBAs did not know the causes of excessive blood loss, they knew that anaemia was a risk factor for dying from PPH. The TBAs were keen to improve their knowledge and to participate in further training. KEY CONCLUSIONS: although all the TBAs were illiterate, information from training programmes had usually been incorporated into their knowledge and practice. While the local infrastructure remains poor, home deliveries and delayed referrals will continue and interventions for PPH need to be effective at the site of delivery i.e. in the woman's home. These Gambian TBAs have the potential to contribute to the management of PPH in these situations. IMPLICATIONS FOR PRACTICE: these Gambian TBAs could be trained to implement other practices relevant to prevention of PPH in the primary care setting. Linking together and maximising the skills of all health workers is important to reduce PPH mortality in home births in this setting.

Adolescent↗

PubMed2001

Laminaria versus extra-amniotic saline solution infusion for cervical ripening in second-trimester labor inductions.

OBJECTIVE: The aim of this study was to determine which cervical ripening method, laminaria placement or extra-amniotic saline solution infusion, was associated with the shorter interval from induction to delivery in the second trimester. STUDY DESIGN: Women admitted for indicated second-trimester labor induction with an unfavorable cervix were randomly assigned to receive either intracervical placement of laminaria (n = 25) or extra-amniotic saline solution infusion (n = 25) with concurrent concentrated oxytocin and vaginally administered prostaglandin E2 (10 mg every 6 hours). Treatment success was defined as an interval from induction to delivery of < or =24 hours. RESULTS: Maternal age, race, parity, gestational age, and initial cervical dilatation were similar between the groups. Indications for uterine evacuation were also similar and included fetal death (n = 7), aneuploidy (n = 20), fetal structural anomaly (n = 18), and maternal indications (n = 4). There was no difference in the mean intervals from induction to delivery (laminaria, 16 +/- 8 hours, vs extra-amniotic saline solution infusion, 17 +/- 10 hours) or the number of treatment successes (laminaria, n = 23, vs extra-amniotic saline solution infusion, n = 21). Retained placenta, live birth, and hemorrhage occurred with similar frequencies in the two groups. CONCLUSION: Relative to laminaria, extra-amniotic saline solution infusion did not shorten the induction-to-delivery interval in women undergoing indicated second-trimester labor induction with concentrated oxytocin and low-dose vaginally administered prostaglandin E2.

Abortion, Induced↗

PubMed1990

Second-trimester termination with 16,16 dimethyl-PGE1-methyl ester (gemeprost), compared with a regimen that included intra-amniotic PGF2 alpha and hypertonic saline.

The use of gemeprost (16,16 dimethyl-PGE1-methyl ester) pessaries was compared in an open, randomized single-centre trial with the intra-amniotic injection of PGF2 alpha combined with hypertonic saline, intravenous oxytocin and a hygroscopic cervical dilator (Dilapan) for the termination of pregnancy between 14 and 20 weeks. There was no significant difference in the induction-delivery interval for the two groups. With the exception of an increased incidence of diarrhoea in the gemeprost group, there was no significant difference in other side effects, analgesic requirements or retained placentae. Gemeprost pessaries are an effective alternative to the more invasive methods previously used for the induction of second-trimester termination.

Abortifacient Agents, Nonsteroidal↗

PubMed1997

The effects of smoking on labour after uncomplicated pregnancy: a comparison between the progress and outcome of labour in 400 smokers and 400 matched non-smokers.

A comparison was made between the progress of labour and its outcome after an uncomplicated pregnancy, in 400 smokers and 400 non-smokers. Strict selection criteria were applied to eliminate, as far as possible, the variables which might have influenced labour in both groups and to ensure that the two groups of women were matched. The duration of labour was longer in smokers, who also had a higher incidence of caesarean sections. Smokers had a higher incidence of retained placenta and postpartum haemorrhage. The neonates of smokers had a higher incidence of problems in the immediate post-delivery period.

Journal Article↗

PubMed1999

Induced abortion and duration of third stage labour in a subsequent pregnancy.

We set out to evaluate the impact of first trimester induced abortion on the duration of third stage labour and related complications in a subsequent pregnancy. The study was conducted in Shanghai city at 15 general hospitals (or maternity and infant health institutes) from November 1993 to March 1998. We identified all nulliparae who came for antenatal care within the first 63 days of pregnancy (2953); the women were divided into two cohorts according to their previous history of first trimester induced abortion. After enrollment, the women were interviewed five times from recruitment until 42 days after delivery. We included in the study all 1363 women who had a singleton vaginal live birth. Of these women, 703 were primigravida (non-exposed), 534 had had one previous first trimester induced abortion, and 126 women had had two or more first trimester induced abortions. The duration of third stage labour in minutes was longer in women with one or more previous induced abortions (mean=7.32 minutes) compared with primigravid women (mean=6.79 minutes). Prolonged third stage labour (>30 minutes) following one or more induced abortions was seen for 3.4% versus 1.0% in primigravid women. After adjusting for a number of potential confounders, women with one or more previous first trimester induced abortions had an odds ratio of prolonged third stage labour of 2.59 (95%C.I.=1.06-6.37) compared with primigravida, especially after an interpregnancy interval of more than 6 months (OR=3.24, 95%C.I.=1.29-8.13). The odds ratio of prolonged third stage labour was 3.14 (95%C.I.=1.22-8.09) if gestational age at the time of the induced abortion exceeded 49 days. Women with a first trimester induced abortion had no significantly increased risk of postpartum haemorrhage or retained placenta. It was concluded that a history of one or more first trimester induced abortions was related to an increased risk of prolonged third stage labour in the following pregnancy, particularly if the induced abortion was performed after 49 days of gestation.

Journal Article↗

PubMed2005

Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study.

OBJECTIVE: The study was aimed to identify obstetric risk factors for early postpartum hemorrhage (PPH) in singleton gestations and to evaluate pregnancy outcome. STUDY DESIGN: A comparison between consecutive singleton deliveries with and without early PPH was performed. Deliveries occurred during the years 1988-2002 in a tertiary medical center. A multivariate logistic regression model was constructed in order to define independent risk factors for PPH. RESULTS: Postpartum hemorrhage complicated 0.4% (n = 666) of all deliveries enrolled in the study (n = 154 311). Significant risk factors for PPH, identified using a multivariable analysis, were: retained placenta (OR 3.5, 95%CI 2.1-5.8), failure to progress during the second stage of labor (OR 3.4, 95%CI 2.4-4.7), placenta accreta (OR 3.3, 95%CI 1.7-6.4), lacerations (OR 2.4, 95%CI 2.0-2.8), instrumental delivery (OR 2.3, 95%CI 1.6-3.4), large for gestational age (LGA) newborn (OR 1.9, 95%CI 1.6-2.4), hypertensive disorders (OR 1.7, 95%CI 1.2-2.1), induction of labor (OR 1.4, 95%CI 1.1-1.7) and augmentation of labor with oxytocin (OR 1.4, 95%CI 1.2-1.7). Women were assigned into three different groups according to the assessed severity of PPH, assuming that the severe cases were handled by revision of the birth canal under anesthesia, and the most severe cases required in addition treatment with blood products. A significant linear association was found between the severity of bleeding and the following factors: vacuum extraction, oxytocin augmentation, hypertensive disorders as well as perinatal mortality, uterine rupture, peripartum hysterectomy and uterine or internal iliac artery ligation (p < 0.001 for all variables). CONCLUSION: Hypertensive disorder, failure to progress during the second stage of labor, oxytocin augmentation, vacuum extraction and LGA were found to be major risk factors for severe PPH. Special attention should be given after birth to hypertensive patients, and to patients who underwent induction of labor or instrumental delivery, as well as to those delivering LGA newborns.

Arteries↗

PubMed2001

Oxytocin use in grand-multiparous patients: safety and complications.

OBJECTIVE: To determine whether the use of oxytocin for the augmentation of labor in grandmultiparous women increases the risk of peripartum complications. STUDY DESIGN: During the years 1989-97, 11 075 grand-multiparous women delivered at our institution. In 424 grand-multiparous women, intravenous oxytocin was used for augmentation of labor. The control group consisted of the other 10 651 grand-multiparous women. All women were monitored for fetal heart rate and uterine contractions. We compared the rates of maternal and perinatal complications in these two groups by using chi(2) analysis and Fisher's exact test when appropriate. RESULTS: No significant differences were found between the oxytocin and the control groups in the rates of placental abruption, intrapartum fetal death, postpartum hemorrhage, uterine rupture, fetal distress, meconium-stained amniotic fluid, an Apgar score of less than 7 at 5 min, Cesarean section, retained placenta and vaginal and cervical lacerations. In contrast, a significant increase in the rate of vacuum deliveries was observed in patients given oxytocin as compared to controls (3.5% vs. 1.4%, respectively; p = 0.001). CONCLUSIONS: The use of oxytocin in the grand-multiparous parturient was a safe procedure with no significant increase in peripartum complications. However, a higher rate of vacuum deliveries was found.

Adult↗

PubMed1979

Experience with spinal analgesia in a British obstetric unit.

A series of 443 spinal anaesthetics is described. The procedures included operative vaginal delivery, removal of retained placenta and a miscellaneous group common to most obstetric units. Failure to provide effective relief of pain occurred in 5.2% of patients. There was one potentially serious complication, but with this exception hypotension was not a feature. Headache following spinal analgesia was experienced by 16.3% of patients, the frequency being greater among those who received spinal analgesia at or shortly after delivery, but was unrelated to the size of the needle (23-gauge of 25-gauge) used. Extradural blood patch promptly and permanently cured the headache. The duration of sensory and motor loss after operation varied considerably with the local anesthetic agent used. The re-introduction of spinal analgesia into British obstetric anaesthetic practice is advocated.

Anesthesia, Obstetrical↗

PubMed1994

Influence of fetectomy on serum pregnancy-associated plasma protein-A concentrations in the baboon.

In baboons as in humans, the placenta is a source of various peptides, including pregnancy-associated plasma protein-A (PAPP-A). However, our present understanding of the regulation of PAPP-A production is incomplete. We have demonstrated that after fetectomy, the baboon placenta retains steroidogenic capacity and is maintained in utero until delivered spontaneously close to term. We have suggested, therefore, that fetectomy provides a valuable in vivo approach to elucidating the role(s) of the fetus, and of the hormones (e.g., estrogen and progesterone) dependent upon the presence of the fetus, in the regulation of placental steroidogenesis during primate pregnancy. Therefore in the present study we utilized the fetectomy model to evaluate the respective roles of the fetus, estrogen, and progesterone on placental PAPP-A. Estradiol, progesterone, and PAPP-A concentrations were determined by RIA in maternal blood collected under ketamine anesthesia on Days 78-100 (n = 5), Days 102-144 (n = 4), and Days 146-164 (n = 3) of gestation (term = Day 184) in control baboons (Papio anubis) and on Days 110-164 in baboons fetectomized on Day 100 (n = 9). Studies were also conducted in five animals in which placental estrogen was increased by maternal treatment on Days 70-100 with androstenedione and in three animals treated on Days 140-164 with the antiestrogen, ethamoxytriphetol (MER-25; 25 mg/day/kg BW).(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗

PubMed1998

Placental tissue enhances uterine relaxation by nitroglycerin.

UNLABELLED: Nitroglycerin (TNG) has recently gained popularity in obstetric anesthesia for facilitating acute uterine relaxation in the treatment of obstetric emergencies such as retained placenta. Laboratory investigations, however, have consistently found the uterus insensitive to clinically used doses of TNG. We hypothesized that the presence of the placenta in the uterus may be important for TNG to be effective, because it has been present in most clinical reports and has generally been absent in laboratory investigations. Sections of near-term gravid rat uteri were mounted for isometric force recording. We studied spontaneous contractions and acetylcholine-induced sustained contractions both with and without the addition of minced placental tissue in close approximation to the uterine muscle. Phenylephrine-precontracted rings of thoracic aorta were studied as a positive control. Log dose-response curves for TNG, 10(-9) to 10(-5) M, were constructed for each tissue. Uterine muscle alone was resistant to all but the largest doses of TNG, both in spontaneous and sustained contraction models. The addition of placental tissue caused a marked increase in sensitivity, reducing spontaneous uterine contractions by 50% at log -5.92 M (95% confidence interval, -6.49, -5.05), which was comparable to the sensitivity in aorta. Nitric oxide (NO) inhibitors pyrogallol (a superoxide anion generator) and methylene blue (a guanylate cyclase inhibitor) completely blocked the effect of TNG in the presence of placenta. Placental tissue modestly increased the response of aorta to TNG, but not of uterine tissue to the NO-independent uterine relaxants MgSO4 and terbutaline. IMPLICATIONS: Nitroglycerin can relax the human uterus during obstetric emergencies, but the drug has never been proven effective in the laboratory. This study shows that nitroglycerin can relax uterine contractions in the rat, provided that the placenta is adjacent to the uterus. The mechanism seems to be via the release of nitric oxide.

Acetylcholine↗

PubMed1995

Postpartum haemorrhage.

Most cases of postpartum haemorrhage are caused by uterine atony, maternal soft-tissue trauma, retained placenta or its parts, and obstetric coagulopathy. The factors most significantly associated with haemorrhage include advanced maternal age, prolonged labour, pre-eclampsia, obesity of mother, multiple pregnancy, a birth weight of more than 4000g, and previous postpartum haemorrhage. It seems that multiparity itself is only a weakly associated factor. The prophylactic use of oxytocic drugs (oxytocin or its combination with ergometrine at the third stage of labour is always recommended for decreasing the bleeding. Prostaglandins should be used as a second line treatment if uterine atony cannot be abolished by uterine massage and oxytocin infusion. In the surgical management, the role of hypogastric artery ligation is decreasing. The stepwise uterine devascularization may be a reasonable method in the most severe uncontrollable postpartum bleeding. The uterine tamponade with gauze or specific tubes may also be a useful alternative in some cases. Selective arterial embolization is a promising new method that seems to have success in controlling the heavy postpartum bleeding unresponsive to more usual measures. However, the value of this method should be evaluated in bigger series.

Female↗

PubMed2004

Risk factors and outcomes associated with a short umbilical cord.

OBJECTIVE: To identify risk factors and outcomes associated with a short umbilical cord. METHODS: We conducted a population-based case-control study using linked Washington State birth certificate-hospital discharge data for singleton live births from 1987 to 1998 to assess the association between maternal, pregnancy, delivery, and infant characteristics and short umbilical cord. Cases (n = 3565) were infants diagnosed with a short umbilical cord. Controls (n = 14260) were randomly selected from among births without a diagnosis of short umbilical cord. RESULTS: Case mothers were less likely to be overweight (body mass index 25 or more, odds ratio [OR] 0.7; 95% confidence interval [CI] 0.6, 0.8) and more likely to be primiparous (OR 1.4; 95% CI 1.3, 1.6). Case infants were more likely to be female (OR 1.3; 95% CI 1.2, 1.4), have a congenital malformation (OR 1.6; 95% CI 1.4, 1.8), and be small for their gestational age (risk ratio [RR] 1.6; 95% CI 1.4, 1.9). A short cord was associated with increased risk for maternal labor and delivery complications, including retained placenta (RR 1.6; 95% CI 1.2, 2.3) and operative vaginal delivery (RR 1.4; 95% CI 1.3, 1.5). Adverse fetal and infant outcomes in cases included fetal distress (RR 1.8; 95% CI 1.6, 2.1) and death within the first year of life among term infants (RR 2.4; 95% CI 1.2, 4.6). CONCLUSION: Modifiable risk factors associated with the development of a short cord were not identified. Case mothers and infants are more likely to experience labor and delivery complications. Term case infants had a 2-fold increased risk of death, which suggests closer postpartum monitoring of these infants.

Adult↗

PubMed2004

Outcome of pregnancy in homozygous sickle cell disease.

OBJECTIVE: Previous reports on pregnancy in homozygous sickle cell (SS) disease are biased by hospital-based, more severely affected subjects and may have underestimated recurrent early pregnancy losses. We report pregnancy outcome in a representative sample of SS subjects subsequently referred to as "subjects" or "sickle cell subjects," and matched normal controls followed from birth. METHODS: The outcomes of 94 pregnancies in 52 subjects and 157 pregnancies in 68 controls followed in a cohort study from birth are presented. Outcome measures included the age at menarche, interval to first pregnancy, outcome of pregnancy, and maternal complications. Possible predictors of low birth weight are assessed. Outcomes were compared by the Kaplan-Meier analysis for interval to first pregnancy and by Student t test, chi(2) test, or Fisher exact test, as appropriate. Correction was made for multiple testing, and multiple linear regression was used for analysis of birth weight. RESULTS: Compared with controls, SS subjects had later menarche (median age 15.4 versus 13.0 years) and first pregnancy (median age 23.7 versus 20.1 years), and more spontaneous abortions (36% versus 10%). Babies of SS subjects had a lower gestational age (P <.001) and lower birth weight (P <.001), the latter being significantly affected by sickle-related events in pregnancy. There was no difference in pregnancy-induced hypertension, preeclampsia, or antepartum or postpartum hemorrhage, but a retained placenta was marginally more common in SS subjects (Fisher exact test, P =.007 after adjustment for multiple testing). Two SS subjects died, a mortality rate of 2.1%. CONCLUSION: The increased fetal loss and maternal morbidity in mothers with homozygous sickle cell disease is confirmed. LEVEL OF EVIDENCE: II-2

Abortion, Spontaneous↗