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PubMed2002

The risk of lower urinary tract symptoms five years after the first delivery.

AIM OF THE STUDY: To estimate the prevalence and 5-year incidence of lower urinary tract symptoms (LUTS) after the first delivery and to evaluate the impact of pregnancy per se and delivery per se on long-lasting symptoms. MATERIALS AND METHODS: A longitudinal cohort study of 305 primiparae questioned a few days, 3 months, and 5 years after their delivery. The questionnaire used was tested and validated, and the questions were formulated according to the definitions of the International Continence Society (ICS). Maternal, obstetric, and neonatal data concerning every delivery and objective data concerning surgeries during the observation period were obtained from the records. From the sample of 278 women (91%) who responded 5 years after their first delivery, three subpopulations were defined: 1) women without initial LUTS before or during the first pregnancy or during the puerperal period, 2) women with onset of LUTS during the first pregnancy, and 3) women with onset of LUTS during the first puerperium. The risk of LUTS 5 years after the first delivery was examined using bivariate analyses. The obstetric variables in the bivariate tests with a significant association with long-lasting urinary incontinence were entered into a multivariate logistic regression. RESULTS: The prevalence of stress and urge incontinence 5 years after first delivery was 30% and 15%, respectively, whereas the 5-year incidence was 19% and 11%, respectively. The prevalence of urgency, diurnal frequency, and nocturia 5 years after the first delivery was 18%, 24%, and 2%, respectively, whereas the 5-year incidence was 15%, 20%, and 0.5%, respectively. The prevalence of all LUTS except nocturia increased significantly during the 5 years of observation. The risk of long-lasting stress and urge incontinence was related to the onset and duration of the symptom after the first pregnancy and delivery in a dose-response-like manner. Vacuum extraction at the first delivery was used significantly more often in the group of women with onset of stress incontinence during the first puerperium, whereas an episiotomy at the first delivery was performed significantly more often in the group of women with onset of stress incontinence in the 5 years of observation. The prevalence of urgency and diurnal frequency 5 years after the first delivery was not increased in women with symptom onset during the first pregnancy or puerperium compared with those without such symptoms. The frequency of nocturia 5 years after the first delivery was too low for statistical analysis. CONCLUSION: The first pregnancy and delivery may result in stress and urge incontinence 5 years later. Women with stress and urge incontinence 3 months after the first delivery have a very high risk of long-lasting symptoms. An episiotomy or a vacuum extraction at the first delivery seems to increase the risk. Subsequent childbearing or surgery seems without significant contribution. Long-lasting urgency, diurnal frequency, or nocturia cannot be predicted from onset during the first pregnancy or puerperium.

Adolescent↗

PubMed1984

Prophylactic insulin treatment of gestational diabetes reduces the incidence of macrosomia, operative delivery, and birth trauma.

Four hundred and forty-five gestational diabetic women who were delivered over a 5-year period were evaluated. One hundred and fifteen were treated with insulin and diet, 184 with diet alone, and 146 with neither insulin nor dietary manipulation. The incidence of babies weighing more than 4000 gm was 7% in the insulin-treated group, 18.5% in the diet-treated group, and 17.8% in the untreated group (p less than 0.05). The incidence of operative delivery (midforceps, midcavity vacuum extraction, or primary cesarean section) was 16.3% in the insulin-treated group, 30.4% in the diet-treated group, and 28.5% in the untreated group (p less than 0.05). The incidence of birth trauma (shoulder dystocia, Erb's palsy, cephalhematoma, soft tissue injury) was 4.8% in the insulin-treated group, 13.4% in the diet-treated group, and 20.4% in the untreated group (p less than 0.05). These data suggest that prophylactic insulin treatment prevents not only macrosomia but also its sequel of traumatic delivery.

Adult↗

PubMed2002

[HIV infection in pregnant women--clinical findings and treatment].

BACKGROUND AND METHODS: The paper reviews HIV infection in pregnancy. We have mainly used PubMed for literature searches with focus on risk factors for vertical infection and measures to prevent mother-to-child transmission. RESULTS: The risk of vertical HIV-transmission is greatest when the mother has high levels of viraemia. Antiviral treatment decreases the fetal risk. When the viral load is low, i.e. HIV-RNA below 1000 copies/ml, the risk of infection of the fetus is small; individually adapted antiviral treatment is indicated to obtain this goal. Increased risk of infection of the fetus may occur as a result of vaginal bleeding, amniocentesis, vaginal delivery, the use of scalp electrodes and fetal scalp pH measurement. The use of vacuum extraction and forceps delivery should be avoided if possible. An important factor associated with increased fetal risk is long lasting rupture of the membranes (> 4 hours). INTERPRETATION: Elective delivery by Caesarean section at 38th week, before labour and rupture of the membranes, is advocated. A Caesarean section may, however, cause complications, and vaginal delivery at term may be considered when the viraemia is low (HIV-RNA < 1000 copies/ml). Amniotomy and long-standing rupture of the membranes should be avoided, as should breastfeeding.

Anti-HIV Agents↗

PubMed2003

Trends in major risk factors for anal sphincter lacerations: a 10-year study.

OBJECTIVES: (1) To identify independent risk factors for anal sphincter laceration, (2) to determine the trend in rates of anal sphincter laceration over a 10-year period, and (3) to examine the impact of temporal trends in risk factors on anal sphincter laceration rates. METHODS: Population-based data were obtained from the Nova Scotia Atlee Perinatal Database, on 91 206 women who had a singleton vaginal live birth > or =500 g for the years 1988 to 1997. Risk factors for anal sphincter laceration were identified using stepwise logistic regression. A multivariate model was used to study temporal changes in laceration rates after controlling for changes in parity, episiotomy rates, operative vaginal deliveries, birth weight, prolonged second stage of labour, and other determinants. RESULTS: Nulliparity (relative risk [RR] = 6.97), occiput posterior position (RR = 2.44), non-vertex presentations (RR = 2.27), second stage > or =120 min (RR range = 1.47-2.02), delivery by an obstetrician (RR = 1.30), and birth weight > or =3000 g (RR range = 1.43-6.63) increased the risk of laceration. Instrument-assisted delivery involved risks that ranged from a 2-fold increase for a vacuum-assisted delivery (RR = 2.15) to a greater than 5-fold increase for a forceps delivery after an unsuccessful vacuum extraction (RR = 5.69). Episiotomy, particularly midline incisions, increased the risk of laceration (RR = 2.57). The risk of a sphincter laceration increased 2-fold from 1988 to 1997, despite controlling for risk factors. CONCLUSIONS: Sufficient evidence exists about the risk factors for anal sphincter laceration to permit modification of management of labour and delivery to minimize the risk of anal sphincter laceration. Increased awareness of the clinical importance of recognition and repair of anal sphincter laceration may explain the rising incidence.

Adult↗

PubMed1988

[Risk factors of undescended testis].

A study on possible association of maternal factors with undescended testis was undertaken. A comparison was made using mothers of boys with the disease (No. = 108) and mothers of boys without the disease (No. = 108). The boys without the disease were selected from outpatients by individually matching the birth year with the case. A smaller proportion of mothers having babies with the disease experienced vomiting during the index pregnancy (the estimated relative risk RR = 0.51, P = 0.02). A larger proportion of them had delivered by vacuum extractor delivery, cesarean section, or breech extraction (RR = 2.10, P = 0.04). A higher proportion of cases were complicated with inguinal hernia (RR = 9.00, P = 0.03), congenital cardiac diseases (RR = infinity, P = 0.008), or other various kinds of congenital disorders. A larger proportion of these mothers had never breastfed for the cases (RR = 3.75, P = 0.02). Exposure to external estrogen in the utero was not noted to be associated with undescended testis.

Analysis of Variance↗

PubMed1997

Vacuum-assisted vaginal delivery.

Vacuum extraction is an effective method of operative vaginal delivery. The procedure is widely used in Europe and many developing countries as the instrument of choice for assisted vaginal deliveries and has recently gained greater acceptance in the United States. The vacuum procedure is relatively easy to learn and offers a safer, less traumatic alternative to the use of forceps or cesarean section for indicated deliveries. Advances in extractor cup design have resulted in fewer cases of neonatal and maternal trauma and improved efficacy. As with any procedure, strict attention to technique and sound clinical judgment are essential for success.

Delivery, Obstetric↗

PubMedDate not supplied

[Pregnancy and labor associated with encephalopathy in neonates during the early neonatal period].

Pregnancy complications, drugs and surgical interventions during pregnancy, fetal growth, medications and interventions during labor, labor complications as well as fetal heart activity during labor in a group of 114 term infants without malformations, but with signs of central nervous system (CNS) damage throughout early neonatal period are compared with paired group of term healthy infants born in the same presentation and mode of delivery. Among prelabor factors only maternal hypertension (found in 16.7% of encephalopathy children versus 0.8% in a control group) was significantly correlated with CNS damage. Fetal growth retardation and long term ritodrine administration were found more frequent in encephalopathy than in healthy group of infants, although statistical significance between the groups could not be demonstrated. A prolonged second stage of labor, high oxytocin dosage, too frequent uterine contractions and vacuum extractions were found significantly correlated with neonatal encephalopathy. CTG pattern during labor was normal in only 28.9% of children, with encepalopathy prepathologic in 46.4% and pathologic in 24.7%. The respective percentages for healthy newborns were: 82.5%, 16.25% and 1.2%. All differences between the groups were statistically significant. Mean duration of prepathologic CTG score in the group of infants with encephalopathy (78.8 minutes) as well as of pathologic score (51.7 minutes) was significantly longer than in healthy infants (23.7 minutes prepathologic and 7 minutes pathologic).(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Diseases↗

PubMed1990

Congenital brachial palsy in the eastern province of Saudi Arabia.

The clinical features of 57 patients (31 males, 26 females) with congenital brachial palsy seen at the King Fahd Hospital of the University over a 5-year period are described. Delivery was difficult in 32 (56%), 20 (35%) were large babies (birth weight greater than 3,600 g), and 20 deliveries required either forceps or vacuum extraction. The presentation at delivery was vertex in 45, breech in five, and shoulder in four. Associated injuries or features, encountered in 14 cases, were fractures of the clavicle and humerus (six cases each), and skull fracture and Horner's syndrome in one patient each. The right and left sides were involved in 31 and 24 cases, respectively, and both sides in only two cases. All the muscle groups of the affected limb were most commonly involved (40%), and hand muscles alone were affected in only one patient. Although 60% of the cases presented late to the hospital, functional recovery was observed in 63%. The major predisposing factors identified in this study were technically difficult deliveries, large infants, and breech or shoulder presentation with assisted delivery. It is suggested that early identification of these factors and improvement in obstetric care of both the mothers and babies during delivery would reduce the incidence and severity of this disability.

Adolescent↗

PubMed2001

Is breastfeeding really favoring early neonatal jaundice?

OBJECTIVE: The purpose of this study was to evaluate the development of significant hyperbilirubinemia in a large unselected newborn population in a metropolitan area with particular attention to the relationship between type of feeding and incidence of neonatal jaundice in the first week of life. STUDY DESIGN: A population of 2174 infants with gestational age >/=37 weeks was prospectively investigated during the first days of life. Total serum bilirubin determinations were performed on infants with jaundice. The following variables were studied: type of feeding, method of delivery, weight loss after birth in relationship to the type of feeding, and maternal and neonatal risk factors for jaundice. Statistical analyses were performed using the z test for parametric variables and the t test for nonparametric variables. In addition, the multiple logistic regression allows for the estimation of the role of the individual characteristics in the development of hyperbilirubinemia. Data concerning serum bilirubin peak distribution in jaundiced newborns were analyzed using a single and a double Gaussian best fit at least squares. The t test was performed to compare 2 values (high and low) of the serum bilirubin peak in breastfed and supplementary-fed infants with those in bottle-fed infants. RESULTS: The maximal serum bilirubin concentration exceeded 12.9 mg/dL (221 micromol/L) in 112 infants (5.1%). The study demonstrated a statistically significant positive correlation between patients with a total serum bilirubin concentration >12.9 mg/dL (221 micromol/L) and supplementary feeding; oppositely, breastfed neonates did not present a higher frequency of significant hyperbilirubinemia in the first days of life. However, best Gaussian fitting of our data suggests that a small subpopulation of breastfed infants have a higher serum bilirubin peak than do bottle-fed infants. Newborns with significant hyperbilirubinemia underwent a greater weight loss after birth compared with the overall studied population, and infants given mixed feeding lost more weight than breastfed and formula-fed newborns, indicating that formula has been administered in neonates who had a weight loss beyond a predetermined percentage of birth weight. Significant hyperbilirubinemia was also strongly associated with delivery by vacuum extractor, some perinatal complications (cephalohematoma, positive Coombs' test, and blood group systems of A, AB, B, and O [ABO] incompatibility) and Asian origin. Multiple logistic regression analysis shows that supplementary feeding, weight loss percentage, ABO incompatibility, and vacuum extraction significantly increase the risk of jaundice, while only cesarean section decreases the risk. CONCLUSION: The present study confirms the important role of fasting in the pathogenesis of neonatal hyperbilirubinemia, although breastfeeding per se does not seem related to the increased frequency of neonatal jaundice but to the higher bilirubin level in a very small subpopulation of infants with jaundice. In fact, in the breastfed infants, there is a small subpopulation with higher serum bilirubin levels. These infants, when starved and/or dehydrated, could probably be at high risk of bilirubin encephalopathy.

Bilirubin↗

PubMed1978

[Postnatal monitoring of the newborn infant with cardiotachography. II. Significance of cardiotachography for diagnosis of existing conditions in the newborn infant].

Eighty-five cardiotachograms of newborns aged between 34 and 42 weeks of gestation were studied. Fifty newborns were delivered spontaneously. In seventeen cases caesarean sections were used and in eighteen cases vacuum extractions. Cardiotachograms were recorded continuously throughout the immediate postnatal period until the stabilisation of the heart rate. Cardiotachograms were divided into three typical groups based on their cours of heart rate and fluctuation. The relation between these groups and the methods and duration of delivery and the condition of newborns were discussed. We found a correlation between the pathological cardiotachograms (tachycardiac and bradycardiac type of cardiotachogram) and long expulsion time, existent history of intrauterine disorder and low Apgar score. No relationship could be established between pathological cardiotachograms and the method of delivery.

Arrhythmias, Cardiac↗

PubMed1993

[Further comment on the problem of first-time delivery at an age over 30].

The authors concentrate on operative delivery--caesarean section, vacuum extraction and forceps of primiparous women over 30 years of age. Patients are divided in three groups by age--up to 29 years, 30-34 years and over 35. The data from 1992 is compared to already known results concerning the period 1983-1989. A rise in the percentage of caesarean section in the third group--over 35 up to 47.60% is found. The authors point that this is a result of usually unnecessary assurance in connection with age. There is no change in the operative delivery rate in the other two groups. The authors propose further discussion on the problem.

Adult↗

PubMed1998

Outcome of 22 successful pregnancies after liver transplantation.

To evaluate course and outcome of pregnancies in liver transplanted patients and to provide a brief summary on the development of these children, 22 pregnancies and 23 children (1 month-99 months old) of 16 patients who had been liver transplanted at our institution (mean interval from transplantation to pregnancy 43.1 months) were reviewed. Standard immunosuppressive regimen during pregnancy consisted of cyclosporine A (CyA), tacrolimus (FK), azathioprine (Aza) and/or a low-dose steroid therapy. CyA and FK whole blood trough levels were monitored on a routinely basis to keep therapeutic range (CyA 80-150 ng/mL; FK 4-8 ng/mL). No patient had a graft loss and there were no lethal complications. Beside de novo hypertension (n = 3) and preeclampsia (n = 3) problems during pregnancy included one steroid-sensitive rejection at 36 wk gestation, one case of tacrolimus toxicity at 24 wk with complete reconstitution, and one case of de novo choledocholithiasis with recurrent cholangitis. Three cases of infections occurred. In total, 23 children, including one set of twins, were born. Terms of gestation (mean = 38.1 wk, +/- 2.2 SD), deliveries (spontaneous n = 13, cesarean section n = 7, forceps n = 1, vacuum extraction (VE) n = 1) and birth weights (2876 g, +/- 589.3 SD) were typical. Three pregnancies were preterm, one being a twin pregnancy. Neither congenital malformations nor unusual infections were seen in the children. Postnatal follow-up revealed appropriate physical growth to date. Psychological development seems to be adequate. Our data indicate that successful pregnancies after liver transplantation (LTX) under careful management by transplant specialists, obstetricians and perinatalogists have a good outcome. So far, neither pre- nor postnatal child development appear to be influenced by maternal immunosuppressive therapy during pregnancy.

Adult↗

PubMed1973

Coagulation changes during termination of pregnancy by prostaglandins and by vacuum aspiration.

Serial studies on coagulation factors were performed on 12 patients having termination of mid-trimester pregnancy by extra-amniotic prostaglandin F(2)alpha and 11 patients terminated by vacuum aspiration during the first trimester. A significant change in the activity of factors V, VII and X, VIII, and X, and a decrease of the prothrombin time and platelet count were found with prostaglandin termination but no such changes occurred during vacuum aspiration. These findings suggest that the coagulation system is activated during induction of mid-trimester abortion with extra-amniotic prostaglandin F(2)alpha. This is probably related to the physiological changes in the coagulation mechanism which occur by the second trimester of pregnancy. Termination of pregnancy in the mid-trimester may, however, be expected to give rise to defective blood coagulation and thromboembolic complications.

Abortion, Induced↗

PubMed2004

Perinatal factors and development of islet autoimmunity in early childhood: the diabetes autoimmunity study in the young.

The objective of this study was to test whether maternal age at delivery, child's birth order, cesarean section, complicated delivery, maternal smoking during pregnancy, or neonatal jaundice predict islet autoimmunity in children at genetically increased risk of type 1 diabetes in a birth cohort with blood draws at ages 9, 15, and 24 months and yearly thereafter. Newborns with diabetes-associated human leukocyte antigen genotypes (n = 938) and offspring or siblings of persons with type 1 diabetes (n = 428) from the Denver, Colorado, metropolitan area were examined from January 1994 to February 2003. Information on perinatal factors was collected by using questionnaires soon after the birth. Islet autoimmunity was defined as positivity for > or = 1 autoantibody to glutamic acid decarboxylase65, insulin, or protein tyrosine phosphatase-2/ICA512 at > or = 2 consecutive visits (n = 52; mean follow-up, 3.9 years). Complicated delivery (breech, forceps, vacuum extraction) predicted a higher risk of islet autoimmunity (hazard ratio = 2.10, 95% confidence interval: 1.09, 4.05). Increasing maternal age was related to risk of islet autoimmunity among first-degree relatives of persons with type 1 diabetes (hazard ratios = 3.96 and 8.88 for maternal ages 25-34 and > or = 35 years, respectively, compared with < 25 years; p for trend = 0.008. Other factors evaluated were not related to risk of islet autoimmunity. In conclusion, influences in utero or during delivery may affect the fetal immune system.

Adult↗

PubMed1992

Maternal and other factors of cryptorchidism--a case-control study in Japan.

A case-control study of cryptorchidism was undertaken in Japan. A hundred and eight mothers of children with cryptorchidism and mothers of their matched controls were surveyed. After 4 pairs which consisted of one of twin siblings either in the cases or the controls were excluded, 104 paired data of singletons were analyzed. As a result, a significantly smaller proportion of the case mothers had suffered from vomiting during the index pregnancy than that of the control mothers (odds ratio, or OR = 0.50, 95% confidence interval, or CI 0.28-0.89). A significantly larger proportion of the case mothers had delivered the index child by vacuum or breech extraction, or Caesarean section than that of the control mothers (OR = 2.09, 95% CI 1.01-3.98). A significantly larger proportion of the case mothers had never breast-fed the index child than that of the control mothers (OR = 3.50, 95% CI 1.20-10.21). Significantly larger proportions of the cases had inguinal hernia (OR = 9.00, 95% CI 1.29-62.97), or congenital cardiac diseases (OR = 8/0, p < 0.05) than those of the controls. It was inferred that endogenous hormonal milieu of a mother, rather than exogenous hormones, might be associated with the occurrence of cryptorchidism.

Birth Weight↗

PubMed1996

Disturbed anal sphincter function following vaginal delivery.

BACKGROUND: Recently interest in idiopathic (neurogenic) faecal incontinence has swung from denervation of the external anal sphincter to the internal sphincter. AIMS: To evaluate the effects of vaginal delivery on the internal sphincter. SUBJECTS: 1372 mothers were studied antenatally and 1202 were accepted into the study. METHODS: Sphincter pressures were measured antenatally, in the early postnatal period, and six to 10 weeks later in selected patients. RESULTS: 755 of 1202 subjects assessed antenatally were primiparous women and 447 multiparous women. Some 320 previous spontaneous vaginal deliveries (SVD) (mean 59 mm Hg) and 67 previous forceps deliveries (mean 58 mm Hg) had lower resting pressures than 755 primiparous women (mean 66 mm Hg) (p < 0.01). A total of 493 subjects were reassessed postnatally. There were 372 SVDs, 47 vacuum extractions, 20 forceps, and 54 caesarean deliveries. All vaginal deliveries but not caesarean sections dropped their resting anal pressures from antenatal values (p < 0.001). Some 227 first SVDs had a much greater fall than 145 subsequent SVDs. In 162 subjects who had undergone their first vaginal delivery and who were followed up there was some recovery but the resting pressures were still lowered at six to 10 weeks post partum. CONCLUSIONS: The first vaginal delivery causes a permanent lowering of resting anal pressures. The possible reasons for this are discussed.

Adolescent↗

PubMed2002

Deliveries in maternity homes in Norway: results from a 2-year prospective study.

BACKGROUND: The study aims to report the short-term outcome for the mothers and newborns for all pregnancies accepted for birth at maternity homes in Norway. METHODS: A 2-year prospective study of all mothers in labor in maternity homes, i.e. all births including women and newborns transferred to hospital intra partum or the first week post partum. RESULTS: The study included 1275 women who started labor in the maternity homes in Norway; 1% of all births in Norway during this period. Of those who started labor in a maternity home, 1217 (95.5%) also delivered there while 58 (4.5%) women were transferred to hospital during labor. In the post partum period there were 57 (4.7%) transferrals of mother and baby. Nine women had a vacuum extraction, one had a forceps and three had a vaginal breech (1.1% operative vaginal births in the maternity homes). Five babies (0.4%) had an Apgar score below 7 at 5 min. There were two (0.2%) neonatal deaths; both babies were born with a serious group B streptococcal infection. CONCLUSION: Midwives and general practitioners working in the districts can identify a low-risk population (estimated at 35%) of all pregnant women in the catchment areas who can deliver safely at the maternity homes in Norway. Only 4.5% of those who started labor in the maternity homes had to be transferred to hospital during labor.

Birthing Centers↗

PubMed2001

Cranial birth injuries in term newborn infants.

While cranial birth injuries in term infants are well recognized, to date, only small case series have been described. In an attempt to further define the spectrum of cranial birth injuries, we analyzed 41 consecutive cranial birth injuries at our institution over the period 1991-1998. The most common clinical presentations were apnea (39%) and seizures (37%). Average Apgar scores were 5.7 at 1 min and 7.3 at 5 min; 54% of infants had abnormally low Apgar scores at 1 min and 31% had abnormally low scores at 5 min. The most common intracranial lesion was subdural hemorrhage, present in 73% of infants; most had either a tentorial (57%) and/or interhemispheric (50%) location. Operative treatment was required in 5 infants (12%). Two of the 41 infants (4.8%) died. The study group was compared with a control group of 63 randomly selected births without cranial injury. Using a stepwise logistic regression model, independently significant variables included neonatal birth weight, Apgar scores at 1 and 5 min and mode of delivery. Compared with the controls, the study group had a significantly higher incidence of forceps and/or vacuum deliveries. Combining vacuum, forceps and urgent cesarean section deliveries together as 'urgent' and elective cesarean and spontaneous vaginal deliveries as 'nonurgent', we could find no significant differences between these two groups. Our data conflict with those of Towner et al. [N Engl J Med 1999;341:1709-1714], and suggest that the method of assisted delivery, rather than the urgency of the delivery or dysfunctional labor per se, is a more important variable in cranial birth injuries.

Apgar Score↗