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PubMed1988

Factors associated with maternal mortality in Addis Ababa, Ethiopia.

A housing probability survey in which 9315 women were interviewed was conducted in 1983 to detect the incidence and aetiology of maternal mortality in Addis Ababa, Ethiopia. Maternal mortality for the two-year period from 11 September 1981 was 350/100,000 livebirths (excluding abortions). A logistic regression analysis selected antenatal care, occupation and income as risk factors for maternal mortality, after adjusting for age, parity, education and marital status. Odds ratios were 2.5 for unbooked women compared to those receiving antenatal care, about 3 for students, and maids/janitresses compared to housewives, and between 3 and 5 for those earning less than US$25 monthly, compared to those earning US$150 or more.

Adolescent↗
PubMed1992

Job stress and adverse outcome of pregnancy: a causal link or recall bias?

A case-base study in a population of 214,108 commercial and clerical female workers in Denmark during the period 1983-1985 investigated whether increasing job stress, defined as increasing job demands and decreasing job control, increased the risk of an adverse outcome of pregnancy. Information on the cohort, the outcome of 24,362 pregnancies, was obtained by linkage with nationwide health registers. Six case groups were selected: 1) 2,248 spontaneous abortions, 2) 209 stillbirths or deaths within the first year of life, 3) 661 infants with congenital malformations, 3) 593 preterm deliveries, 4) 587 infants with term low birth weights, 5) 988 infants with light-for-date birth weights, and 6) a random sample of 2,252 pregnancies that constituted the reference group. Information on exposure was obtained by mailed questionnaire. When dichotomized scales on data concerning job demand and control were used, there was an increased relative risk of spontaneous abortion (odds ratio = 1.28, 95% confidence interval (CI) 1.05-1.57) and term low birth weight (odds ratio = 1.46, 95% CI 1.05-2.04) for women experiencing high job stress. For the other case groups, the odds ratios were as follows: congenital malformation, 1.23 (95% CI 0.93-1.63); preterm delivery, 1.03 (95% CI 0.77-1.39); light-for-date birth weight, 1.08 (95% CI 0.83-1.40); and stillbirth/death within the first year of life, 1.42 (95% CI 0.90-2.24). No substantial response bias was found. When occupational titles were used as an exposure matrix, no increased risk was found, except for term low birth weight. Recall bias is one possible explanation. Thus, the results must be interpreted with caution.

Adolescent↗
PubMed1990

How Escherichia coli RNA polymerase can negatively regulate transcription from a constitutive promoter.

We previously described the structures and functions of specific complexes between the bla promoter from Tn3 (present in pBR322) and RNA polymerase (RNAP), showing that, at excess RNAP, complexes can form in which one or two RNAPs bind to the same promoter (1:1 and 2:1 complexes) (Duval-Valentin and Ehrlich, 1988). We report here that the 2:1 complex cannot be detected below 25 degrees C; above that temperature, a 1:1 complex forms at a rate one order of magnitude faster than that of the 2:1 complex, and above 30 degrees C, the amounts of both species become equal for RNAP/promoter ratio r30 less than or equal to r less than or equal to 70. The 2:1 complex decays back to a 1:1 complex losing the last RNAP at a rate about three times that of the 1:1 complex decay. Functional assays of the complexes formed at excess RNAP show that both 1:1 and 2:1 complexes are immediately and permanently inhibited, even when the promoters are pre-incubated with ribonucleotide selections potentially enabling entrance into abortive cycling or formation of a stressed complex. We conclude that the inhibition step probably takes place in the complex formation pathway between RPi and RPo, at a novel stable intermediate isomer, RPj, formed above 25 degrees C. A possible mechanism of formation of the 2:1 complex is outlined. In vivo studies, in which r was modified by varying the bacterial growth rate, show a reduction of bla expression as r values are upshifted, specific to the bla promoter from Tn3.

DNA-Directed RNA Polymerases↗
PubMed1978

Meckel syndrome and the prenatal diagnosis of neural tube defects.

Two fetuses, terminated after prenatal diagnosis of aneural tube defect, had Meckel syndrome. There have now been three fetuses with this syndrome in a series of 35 terminated because of open lesions of the neural tube. It is suggested that such therapeutically aborted fetuses represent a highly selected group, among which a rare condition like Meckel syndrome will be concentrated. The need for a detailed examination of all terminated fetuses is emphasised, for the identification of such an autosomal recessive condition alters the genetic counselling for a future pregnancy.

Abnormalities, Multiple↗
PubMed1997

Design and results of the Women's Health Study.

The Women's Health Study was a methodological experiment carried out in Chicago. More than 1,000 women took part; a comparison sample of 100 men was also included. The sample was selected from two sources. Most of the women and all of the men were selected from an area probability sample that had been screened to identify women in the eligible age range; the rest of the women were selected from rosters at cooperating abortion clinics and were known to have had an abortion. Questionnaires based on the one used in the National Survey of Family Growth were administered to the sample; the questionnaire included items on abortion, sexual behavior, and illicit drug use. The experiment examined five variables: whether the questionnaire began with a series of medical questions or with questions on pregnancy; whether the interview was conducted by a nurse or field interviewer; whether the interview was done at the respondent's home or outside the home; whether the interviewer or respondent administered the questions; and whether the data were collected on paper or via computer. Of the five experimental factors, the one with the most consistent effect was the method of administering the questions. Self-administration significantly increased the reported number of sexual partners, sexually transmitted diseases, and the level of condom use compared to administration by an interviewer. Computer assistance occasionally interacted with the site of the interview to effect reporting. The other two experimental variables-the version of the questionnaire and the data collection staff-had few discernible effects. None of the variables affected reported drug use over the lifetime.

Chicago↗
PubMed1979

Serum progesterone and estradiol in pregnant women selected for progestagen treatment.

Patients with two or more previous spontaneous second trimester abortions and vaginal cytology indicating a poor progestational response in current pregnancies were selected for treatment with Provera (medroxyprogesterone acetate) and/or Delalutin (17 alpha-hydroxyprogesterone caproate). Serum was examined serially for progesterone (P) and estradiol (E) by radioimmunoassay. Serum from 174 untreated patients with no known complications ranging from 6--40 weeks gestation provided normal distribution data. Of 14 progestagen-treated patients, four aborted during the second trimester. These all had chronically low (greater than 50% of observations were less than 1 standard deviation of the normal population) or falling P/E ratios. The rest delivered normal full-term infants although five of the 10 had chronically low P, seven had chronically low P/E ratios, and in one other P/E was falling. Chronically high E contributed to the low P/E ratio in three cases. Thus, these selected cases with poor obstetrical histories demonstrated steroid patterns outside the +/- 1 standard deviation range, although the steroid levels were still within the normal range. Serum progesterone and estradiol analysis may eventually be useful in identifying patients who will best respond to progestagen treatment.

Abortion, Habitual↗
PubMed2001

Association between Chlamydia psittaci seropositivity and abortion in Italian dairy cows.

Although the seroprevalence of Chlamydia psittaci is widespread in Italian dairy herds, its role in inducing genital disorders has not been elucidated. We therefore set up a case-control study to compare seroprevalence to C. psittaci in an aborted-cow population and in a randomly selected control group in the province of Parma (the Po Valley of northern Italy). The true seroprevalence (45%) in aborted cows was significantly higher than that in the control group (24%) (adjusted odds ratio=2.53).

Abortion, Veterinary↗
PubMed1979

Experience with midtrimester abortion.

The midtrimester abortion program at a large community hospital was evaluated. During the 3-year study, 1839 patients aborted in the midtrimester by intraamniotic injection of hypertonic saline, prostaglandin F2alpha or a combination of saline and prostaglandin F2alpha. The method, using a combination of saline and prostaglandin F2alpha together with intracervical laminaria, showed significant reduction in the number of failures (4.3 to 1.0%), reduction in the injection-abortion interval from 33.9 to 14.6 hours, shortening of the hospital stay from 2 1/2 to 1 1/3 days, minimum incidence of live abortions (0.9%), infrequent need for oxytocin to effect delivery (7.7%); and low rates of hemorrhage (1.5%) and fever (2.8%). The main disadvantage was an increased rate of incomplete abortions (32.3%), which could be reduced to 27% by patient selection.

Abortion, Induced↗
PubMed1978

[Extraamniotic induction of abortion with a new prostaglandin E-2 derivative].

First clinical results are reported of a new prostaglandin-E2-derivative (16-phenoxy-prostaglandin-E2-methylsulfonylamide = SHB 286) as abortifacient using the extraamniotic route of application. Upon investigation in animals this prostaglandin-E2-derivative proved to be more tissue-selective and more potent in inducing abortion than the naturally occurring prostaglandins. Prostaglandin SHB 286(50 or 100 microgram) was applicated to 31 patients for legal abortion and to 7 patients with a missed abortion. The mean instillation-abortion time was 14.2 and 13.7 h respectively. 96% of the patients had a complete or incomplete abortion after 24 hours. Severe local or systemic side effects did not occur and the patients did not need any further medication.

Abortion, Induced↗
PubMed2001

Preimplantation genetic diagnosis of structural abnormalities.

Preimplantation genetic diagnosis (PGD) of translocations can be achieved through a variety of methods. For female carriers, a possibility is by polar body biopsy and analysis of its metaphase chromosomes using painting probes. For male carriers or female carriers with terminal breakpoints, metaphase chromosomes can also be studied by fusing blastomeres to enucleated oocytes. Otherwise, interphase analysis of the translocation can be performed using distal, subtelomeric or breakpoint spanning probes. The results obtained after PGD of translocations indicate a significant decrease in spontaneous abortions after the procedure, a good selection against unbalanced oocytes and embryos, and pregnancy rates that depend on the type of translocation involved. Balanced translocations occur in 0.2% of the neonatal population, but at a higher rate among infertile couples and patients with recurrent abortions. In a recent report, balanced translocations were found in 0.6% of infertile couples, 3.2% of couples that failed over ten IVF cycles, and 9.2% among fertile couples experiencing three or more consecutive first-trimester abortions (Hum. Reprod. 14 (1999) 2097). They were also found in 2-3.2% of males requiring ICSI (Hum. Reprod. 11 (1996) 2609; Hum. Reprod. 13 (1998) 576). PGD can be offered to carriers of balanced translocations as an alternative to prenatal diagnosis and pregnancy termination of unbalanced fetuses. In recent years, PGD for structural chromosome abnormalities has been attempted by a variety of approaches. The aims of PGD for translocations are to reduce the rate of spontaneous abortions that this population suffers and to minimize the risk of conceiving an unbalanced baby.

Abortion, Spontaneous↗
PubMed1984

Sex selection by sperm separation and insemination.

The Ericsson albumin filtration technique was used to collect a fraction rich in Y sperm for selective insemination in couples desiring a male infant. Of 35 conceptions in which sex was known at delivery or spontaneous abortion, there were 28 males (80%). Twelve pregnancies were achieved after separation of sperm in a Sephadex gel filtration system designed to allow for collection of a fraction enriched in X sperm. Seven pregnancies have resulted in females, two in males, and one in twins of each sex. One patient aborted, and one is still pregnant. While selection for either sex can be done electively, on the basis of sociologic preference, female selection has, as an additional indication, avoidance of male offspring to carriers of sex-linked diseases.

Adult↗
PubMed2003

Angiography as treatment for a high cervical tear. A case report.

BACKGROUND: High cervical tears are a rare but serious complication of second-trimester induced abortion. Angiographic embolization can successfully treat selected cases. This is the first case of serious hemorrhage successfully treated by angiography alone, without mechanical occlusion, after failed surgical repair. CASE: A 22-year-old primigravida sustained a high cervical tear during dilation and evacuation (D&E) abortion at 21 weeks' gestation. After stabilization with 4 units of packed red cells and vaginal packing, attempted surgical repair failed. The following day, angiography alone pinpointed and stanched the small arteriolar branch of the uterine artery responsible for the bleeding. CONCLUSION: Injury to a tiny arteriolar branch of the uterine artery during D&E abortion may be impossible to palpate or visualize, and hemostatic sutures placed extrinsically on the cervical mucosa may not be therapeutic. On occasion, injection of contrast material, without mechanical occlusive devices, may be corrective.

Abortion, Therapeutic↗
PubMed1998

Birth outcomes and the effectiveness of prenatal care.

OBJECTIVE: To investigate pregnant women's self-selection effects on the estimation of birthweight production function. A particular emphasis is placed on assessing the effectiveness of prenatal care as a major medical input in the birthweight production function. DATA SOURCES: Primary data compiled from birth and abortion certificates for the Commonwealth of Virginia in 1984. Several area-specific socioeconomic variables were also employed from the Area Resource File 1984; Supplemental Food Program for Women, Infants, and Children (WIC) Local Agency Directory; and the family planning clinics data by the Alan Guttmacher Institute (AGI). STUDY DESIGN: Two types of self-selection effects are defined: selection effect due to sample censoring from the resolution of pregnancies as live births or induced abortions; and selection effect due to the use of prenatal care as an endogenous variable. Race- and location-specific birthweight production functions are estimated using models with and without correction for self-selection effects. PRINCIPAL FINDINGS: The self-selection effect in the resolution of pregnancies is race-specific, being significant for African American women. The effectiveness of prenatal care in birthweight production is underestimated substantially by the selection bias from the use of prenatal care, and overestimated by the selection bias from pregnancy resolutions. On average, the overall estimated effectiveness of prenatal care is over five times higher after controlling for the selection effects. CONCLUSIONS: Self-selection effects could be a very serious problem in measuring the effectiveness of birthweight determinants in general. The overall effectiveness of prenatal care, in particular, tends to be significantly biased downward without controlling for selection effects. The significance and scale of the bias depends crucially on specific data and cohorts of the population investigated.

Abortion, Induced↗
PubMed1989

[Pilot study on assessing medical, psychological and psychosocial factors in stillbirth and spontaneous abortion and recurrent abortion].

84 women (mean age: 29 years) with a history of spontaneous abortion (unexplained in 95% of cases) were compared with a control group (n = 72). Two subgroups, each of 31 women were selected, in which cases with recurrent spontaneous abortion were compared with uncomplicated pregnancies. Psychological disturbances, ineffective coping strategies and medical risk factors were significantly increased in the abortion group, but socioeconomic (occupational, financial) problems linked with higher social class level less importantly. In women with recurrent spontaneous abortions psychological problems and depressive coping modes were predominant, in uncomplicated pregnancies the risk factors were very low. The most frequent psychological disturbances in the abortion group were mourning reactions after pregnancy loss. It appears that psychological factors are less a cause than the consequence of the abortion event. Moreover, both the multifactorial hypothesis of early pregnancy wastage, and the importance of prenatal diagnosis in order to identify possible risk factors, especially in cases of habitual abortion, are stressed.

Abortion, Habitual↗